Provider Demographics
NPI:1538640040
Name:180 DEGREES MENTORING GROUP
Entity Type:Organization
Organization Name:180 DEGREES MENTORING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:SURRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-250-1508
Mailing Address - Street 1:10608 NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-3183
Mailing Address - Country:US
Mailing Address - Phone:317-250-1508
Mailing Address - Fax:
Practice Address - Street 1:10608 NASSAU ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-3183
Practice Address - Country:US
Practice Address - Phone:317-250-1508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty