Provider Demographics
NPI:1235774365
Name:AWARE RECOVERY CARE OF INDIANA, LLC
Entity Type:Organization
Organization Name:AWARE RECOVERY CARE OF INDIANA, LLC
Other - Org Name:PARENT: AWARE RECOVERY CARE, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PAYER RELATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHCROFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-640-0091
Mailing Address - Street 1:35 THORPE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1948
Mailing Address - Country:US
Mailing Address - Phone:203-779-5799
Mailing Address - Fax:
Practice Address - Street 1:6505 E. 82ND STREET
Practice Address - Street 2:#120
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250
Practice Address - Country:US
Practice Address - Phone:317-779-0310
Practice Address - Fax:203-421-6830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AWARE RECOVERY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-13
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility