MEDICARE: VILLAGES OF INDIANA, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253J00000X	Foster Care Agency	50305 49WW	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689849283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGES OF INDIANA, INC

Provider Business Mailing Address
First Line	:	2405 N SMITH PIKE
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47404-1363
Country	:	US
Telephone Number	:	812-332-1245
Fax Number	:	812-333-4717

Provider Business Practice Location Address
First Line	:	612 E BOULEVARD
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-2271
Country	:	US
Telephone Number	:	765-455-8545
Fax Number	:	765-455-8552

Authorized Official
Title or Position	:	COMPIANCE MANAGER
Name	:	MRS. KIMBERLY J DAVIS
Credential	:
Telephone Number	:	812-332-1245

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	04/24/2008

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Directions to “VILLAGES OF INDIANA, INC ” Practice Location

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