Provider Demographics
NPI:1710230081
Name:THE URBAN INITIATIVE
Entity Type:Organization
Organization Name:THE URBAN INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BWANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:317-600-6714
Mailing Address - Street 1:9801 FALL CREEK RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4802
Mailing Address - Country:US
Mailing Address - Phone:317-600-6714
Mailing Address - Fax:
Practice Address - Street 1:9801 FALL CREEK RD
Practice Address - Street 2:SUITE 325
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4802
Practice Address - Country:US
Practice Address - Phone:317-600-6714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health