Provider Demographics
NPI:1659847168
Name:ASSURED RESIDENTIAL AND CONSULTING, LLC
Entity Type:Organization
Organization Name:ASSURED RESIDENTIAL AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:317-426-5948
Mailing Address - Street 1:5555 N TACOMA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3551
Mailing Address - Country:US
Mailing Address - Phone:317-426-5948
Mailing Address - Fax:317-426-5984
Practice Address - Street 1:5555 N TACOMA AVE STE 101
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3551
Practice Address - Country:US
Practice Address - Phone:317-426-5948
Practice Address - Fax:317-426-5984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities