Provider Demographics
NPI:1083386163
Name:BURGEONING RESIDENTIAL CARE LLC
Entity Type:Organization
Organization Name:BURGEONING RESIDENTIAL CARE LLC
Other - Org Name:BURGEONING HEALTH PROVIDERS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:317-506-0024
Mailing Address - Street 1:2345 N ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-4320
Mailing Address - Country:US
Mailing Address - Phone:317-506-0024
Mailing Address - Fax:317-350-0043
Practice Address - Street 1:2345 N ALABAMA ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-4320
Practice Address - Country:US
Practice Address - Phone:317-506-0024
Practice Address - Fax:317-350-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services