Provider Demographics
NPI:1356009880
Name:MENTORING WITH MAGIC HOME SERVICES
Entity Type:Organization
Organization Name:MENTORING WITH MAGIC HOME SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRDSONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-910-1865
Mailing Address - Street 1:5719 LAWTON LOOP EAST DR STE 103
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-2314
Mailing Address - Country:US
Mailing Address - Phone:317-207-0234
Mailing Address - Fax:
Practice Address - Street 1:5719 LAWTON LOOP EAST DR STE 103
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-2314
Practice Address - Country:US
Practice Address - Phone:317-207-0234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services