MEDICARE: ARK SUPPLIERS, LLC

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	101YM0800X	Mental Health Counselor
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1700757804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARK SUPPLIERS, LLC

Provider Business Mailing Address
First Line	:	2532 N TACOMA AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-2785
Country	:	US
Telephone Number	:	317-794-2939
Fax Number	:

Provider Business Practice Location Address
First Line	:	2532 N TACOMA AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-2785
Country	:	US
Telephone Number	:	317-794-2939
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AHMAD KERSEY
Credential	:
Telephone Number	:	317-794-2939

Provider Enumeration Date	:	09/13/2025
Last Update Date	:	04/10/2026

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