Provider Demographics
NPI:1407100969
Name:KITCH HEALTH
Entity Type:Organization
Organization Name:KITCH HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLLAIR
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:KITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-292-1891
Mailing Address - Street 1:994 WOODRUFF PLACE WEST DR
Mailing Address - Street 2:NONE
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-1954
Mailing Address - Country:US
Mailing Address - Phone:317-292-1891
Mailing Address - Fax:
Practice Address - Street 1:994 WOODRUFF PLACE WEST DR
Practice Address - Street 2:NONE
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-1954
Practice Address - Country:US
Practice Address - Phone:317-292-1891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREATE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty