Provider Demographics
NPI:1629136924
Name:CATHOLIC CHARITIES INDPLS, INC
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES INDPLS, INC
Other - Org Name:ADULT DAY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:BETHURAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-236-1530
Mailing Address - Street 1:1400 N MERIDIAN ST.
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2305
Mailing Address - Country:US
Mailing Address - Phone:317-466-0015
Mailing Address - Fax:317-261-3375
Practice Address - Street 1:4609 N. CAPITAL AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208
Practice Address - Country:US
Practice Address - Phone:317-466-0015
Practice Address - Fax:317-261-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200068110BMedicaid
IN200068100AMedicaid