Provider Demographics
NPI:1225251275
Name:INDIANA UNIVERSITY - AREA 9 IN-HOME AND COMMUNITY SERVICES AGENCY
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY - AREA 9 IN-HOME AND COMMUNITY SERVICES AGENCY
Other - Org Name:INDIANA UNIVERSITY
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT VICE PRESIDENT RESEARCH
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-855-3963
Mailing Address - Street 1:520 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-6230
Mailing Address - Country:US
Mailing Address - Phone:765-966-1795
Mailing Address - Fax:765-966-1190
Practice Address - Street 1:520 S 9TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-6230
Practice Address - Country:US
Practice Address - Phone:765-966-1795
Practice Address - Fax:765-966-1190
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANA UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-10
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200348890Medicaid