Provider Demographics
NPI:1346527835
Name:POLARIS COMMUNITY DEVELOPMENT
Entity Type:Organization
Organization Name:POLARIS COMMUNITY DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS
Authorized Official - Phone:317-417-7123
Mailing Address - Street 1:5911 BUICK DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-5322
Mailing Address - Country:US
Mailing Address - Phone:317-417-7123
Mailing Address - Fax:
Practice Address - Street 1:5911 BUICK DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-5322
Practice Address - Country:US
Practice Address - Phone:317-417-7123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2012-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management