Provider Demographics
NPI:1164920682
Name:INDEPENDENT ADULT DAY CARE CENTERS
Entity Type:Organization
Organization Name:INDEPENDENT ADULT DAY CARE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPICCOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-296-8815
Mailing Address - Street 1:1919 E 52ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1381
Mailing Address - Country:US
Mailing Address - Phone:317-296-8815
Mailing Address - Fax:317-608-2802
Practice Address - Street 1:8755 GUION RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3047
Practice Address - Country:US
Practice Address - Phone:317-296-8810
Practice Address - Fax:317-399-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300009813Medicaid