Provider Demographics
NPI:1558322776
Name:VILLAGES OF INDIANA, INC
Entity Type:Organization
Organization Name:VILLAGES OF INDIANA, INC
Other - Org Name:THE VILLAGES
Other - Org Type:Other Name
Authorized Official - Title/Position:COMPLIANCE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-332-1245
Mailing Address - Street 1:2405 N SMITH PIKE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-1363
Mailing Address - Country:US
Mailing Address - Phone:812-332-1245
Mailing Address - Fax:812-333-4717
Practice Address - Street 1:2405 N SMITH PIKE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-1363
Practice Address - Country:US
Practice Address - Phone:812-332-1245
Practice Address - Fax:812-333-4717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Single Specialty