Provider Demographics
NPI:1467689406
Name:ADDICTION RECOVERY CENTERS OF INDIANA, INCORPORATED
Entity Type:Organization
Organization Name:ADDICTION RECOVERY CENTERS OF INDIANA, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-533-6154
Mailing Address - Street 1:114 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-3207
Mailing Address - Country:US
Mailing Address - Phone:574-533-6154
Mailing Address - Fax:
Practice Address - Street 1:114 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-3207
Practice Address - Country:US
Practice Address - Phone:574-533-6154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health