Provider Demographics
NPI:1790954964
Name:PASSWORD COMMUNITY MENTORING, INC.
Entity Type:Organization
Organization Name:PASSWORD COMMUNITY MENTORING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUCKSTEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-472-7903
Mailing Address - Street 1:4720 KINGSWAY DR STE 400
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1580
Mailing Address - Country:US
Mailing Address - Phone:317-585-2791
Mailing Address - Fax:317-472-7899
Practice Address - Street 1:4720 KINGSWAY DR STE 400
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1580
Practice Address - Country:US
Practice Address - Phone:317-585-2791
Practice Address - Fax:317-472-7899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health