Provider Demographics
NPI:1497524730
Name:THE RECOVERY VILLAGE INDIANA, LLC
Entity Type:Organization
Organization Name:THE RECOVERY VILLAGE INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING & LICENSING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURUJON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-785-5520
Mailing Address - Street 1:100 SE 3RD AVE STE 1800
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33394-0011
Mailing Address - Country:US
Mailing Address - Phone:305-785-5520
Mailing Address - Fax:888-919-4431
Practice Address - Street 1:8150 BROOKVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-8903
Practice Address - Country:US
Practice Address - Phone:305-785-5520
Practice Address - Fax:888-919-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility