Provider Demographics
NPI:1548610082
Name:CENTRAL INDIANA CLUBHOUSE NFP CORP
Entity Type:Organization
Organization Name:CENTRAL INDIANA CLUBHOUSE NFP CORP
Other - Org Name:CIRCLE CITY CLUBHOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:317-260-8058
Mailing Address - Street 1:4141 OFFICE PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-2408
Mailing Address - Country:US
Mailing Address - Phone:317-260-8058
Mailing Address - Fax:
Practice Address - Street 1:4141 OFFICE PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2408
Practice Address - Country:US
Practice Address - Phone:317-260-8058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health