Provider Demographics
NPI:1396385886
Name:URBAN ACT ACADEMY
Entity Type:Organization
Organization Name:URBAN ACT ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF SCHOOL
Authorized Official - Prefix:
Authorized Official - First Name:NIGENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-226-4214
Mailing Address - Street 1:1250 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3831
Mailing Address - Country:US
Mailing Address - Phone:317-226-4214
Mailing Address - Fax:
Practice Address - Street 1:1250 E MARKET ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3831
Practice Address - Country:US
Practice Address - Phone:317-226-4214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)