Provider Demographics
NPI:1467824698
Name:ACORN ADDICTION CENTERS LLC DBA JOURNEY ROAD TREATMENT CENTERS
Entity Type:Organization
Organization Name:ACORN ADDICTION CENTERS LLC DBA JOURNEY ROAD TREATMENT CENTERS
Other - Org Name:JOURNEY ROAD TREATMENT CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARI ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-405-8833
Mailing Address - Street 1:1201 N POST ROAD STE. 4
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4225
Mailing Address - Country:US
Mailing Address - Phone:317-405-8833
Mailing Address - Fax:317-672-2398
Practice Address - Street 1:1201 N POST ROAD STE. 4
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-4225
Practice Address - Country:US
Practice Address - Phone:317-405-8833
Practice Address - Fax:317-672-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300025348Medicaid
ININ2829OtherPTAN