MEDICARE: RESOURCE COMMUNITY BASED SERVICES 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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1730494360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESOURCE COMMUNITY BASED SERVICES INC

Provider Business Mailing Address
First Line	:	1404 S STATE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-2009
Country	:	US
Telephone Number	:	317-630-5215
Fax Number	:	317-630-5223

Provider Business Practice Location Address
First Line	:	1404 S STATE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-2009
Country	:	US
Telephone Number	:	317-630-5215
Fax Number	:	317-630-5223

Authorized Official
Title or Position	:	CEO
Name	:	MR. GEORGE B HURD
Credential	:
Telephone Number	:	317-630-5215

Provider Enumeration Date	:	08/06/2010
Last Update Date	:	08/06/2010

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