Provider Demographics
NPI:1639509623
Name:SECURE CARE OF INDIANA
Entity Type:Organization
Organization Name:SECURE CARE OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBOTKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-477-9053
Mailing Address - Street 1:427 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-1550
Mailing Address - Country:US
Mailing Address - Phone:812-477-9053
Mailing Address - Fax:812-477-4127
Practice Address - Street 1:427 S SPRING ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-1550
Practice Address - Country:US
Practice Address - Phone:812-477-9053
Practice Address - Fax:812-477-4127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities