Provider Demographics
NPI:1821267576
Name:ACCESS LLC
Entity Type:Organization
Organization Name:ACCESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:TILLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-728-1372
Mailing Address - Street 1:7437 SHARZAD PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5432
Mailing Address - Country:US
Mailing Address - Phone:317-728-1372
Mailing Address - Fax:
Practice Address - Street 1:7437 SHARZAD PL
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5432
Practice Address - Country:US
Practice Address - Phone:317-728-1372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities