Provider Demographics
NPI:1629328406
Name:ADVANCED PSA FAMILY CENTER
Entity Type:Organization
Organization Name:ADVANCED PSA FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-601-7230
Mailing Address - Street 1:6214 N. MORENCI TRIAL SUITE 220
Mailing Address - Street 2:220
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-4824
Mailing Address - Country:US
Mailing Address - Phone:317-457-4735
Mailing Address - Fax:
Practice Address - Street 1:6214 N. MORENCI TRIAL SUITE 220
Practice Address - Street 2:220
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-4824
Practice Address - Country:US
Practice Address - Phone:317-457-4735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN110119791253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care