Provider Demographics
NPI:1669482642
Name:AIDS RESOURCE GROUP OF EVANSVILLE, INC.
Entity Type:Organization
Organization Name:AIDS RESOURCE GROUP OF EVANSVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REVALEE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:812-421-0059
Mailing Address - Street 1:201 NW 4TH ST
Mailing Address - Street 2:SUITE B-7
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1350
Mailing Address - Country:US
Mailing Address - Phone:812-421-0059
Mailing Address - Fax:812-424-9059
Practice Address - Street 1:201 NW 4TH ST
Practice Address - Street 2:SUITE B-7
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1350
Practice Address - Country:US
Practice Address - Phone:812-421-0059
Practice Address - Fax:812-424-9059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management