Provider Demographics
NPI:1629675012
Name:8530 TOWNSHIP LINE ROAD OPCO LLC
Entity Type:Organization
Organization Name:8530 TOWNSHIP LINE ROAD OPCO LLC
Other - Org Name:RECOVERY CENTERS OF AMERICA AT INDIANAPOLIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORP DIRECTOR, PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLIHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-994-2968
Mailing Address - Street 1:2701 RENAISSANCE BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2781
Mailing Address - Country:US
Mailing Address - Phone:610-994-2968
Mailing Address - Fax:
Practice Address - Street 1:8530 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1927
Practice Address - Country:US
Practice Address - Phone:610-994-2968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder