MEDICARE: ESSENTIAL DEVELOPMENT CORPORATION

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	251S00000X	Community/Behavioral Health Agency	20042020A	IN

General Provider Information

NPI Number	:	1760625446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL DEVELOPMENT CORPORATION

Provider Business Mailing Address
First Line	:	2180 N MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1332
Country	:	US
Telephone Number	:	317-924-2824
Fax Number	:

Provider Business Practice Location Address
First Line	:	2180 N MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1332
Country	:	US
Telephone Number	:	317-924-2824
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. VALERIE MCCRAY
Credential	:	PH,D, H.S.P.P.
Telephone Number	:	317-924-2824

Provider Enumeration Date	:	04/11/2009
Last Update Date	:	04/11/2009

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