Provider Demographics
NPI:1467955484
Name:ASPIRING CHANGE FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:ASPIRING CHANGE FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-442-4085
Mailing Address - Street 1:5170 E 65TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4992
Mailing Address - Country:US
Mailing Address - Phone:317-442-4085
Mailing Address - Fax:
Practice Address - Street 1:5170 E 65TH ST STE 106
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4992
Practice Address - Country:US
Practice Address - Phone:317-442-4085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========Medicaid