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NPI Code Detail

MEDICARE: RAISING BASELINES

MEDICARE: RAISING BASELINES
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1982072492
Entity Type Code : Organization
Provider Name (Legal Business Name) : RAISING BASELINES
Provider Business Mailing Address
First Line : 3133 MERRICK LN
Second Line : 1A
City : INDIANAPOLIS
State : IN
Zip : 46222-1755
Country : US
Telephone Number : 317-362-2652
Fax Number : 317-942-0941
Provider Business Practice Location Address
First Line : 3133 MERRICK LN
Second Line : 1A
City : INDIANAPOLIS
State : IN
Zip : 46222-1755
Country : US
Telephone Number : 317-362-2652
Fax Number : 317-942-0941
Authorized Official
Title or Position : THERAPIST
Name : LENISHA INEZ WATSON
Credential :
Telephone Number : 317-362-2652
Provider Enumeration Date : 09/14/2015
Last Update Date : 09/14/2015

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Directions to “RAISING BASELINES ” Practice Location

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