Provider Demographics
NPI:1609654227
Name:KONDUIIT CARE SYSTEM LLC
Entity Type:Organization
Organization Name:KONDUIIT CARE SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LATEEFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-909-1656
Mailing Address - Street 1:9199 MUIR LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7956
Mailing Address - Country:US
Mailing Address - Phone:317-909-1656
Mailing Address - Fax:
Practice Address - Street 1:9199 MUIR LN
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7956
Practice Address - Country:US
Practice Address - Phone:317-909-1656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities