Provider Demographics
NPI:1043864994
Name:LAY, RAY CHARLES (CHWCRS-SA)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:CHARLES
Last Name:LAY
Suffix:
Gender:M
Credentials:CHWCRS-SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 LAUREN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-7210
Mailing Address - Country:US
Mailing Address - Phone:317-938-2065
Mailing Address - Fax:
Practice Address - Street 1:3414 LAUREN DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-7210
Practice Address - Country:US
Practice Address - Phone:317-938-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty