Provider Demographics
NPI:1922373570
Name:RILEY CHILD DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:RILEY CHILD DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-944-8984
Mailing Address - Street 1:705 RILEY HOSPITAL DR
Mailing Address - Street 2:ROOM 5837
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5109
Mailing Address - Country:US
Mailing Address - Phone:317-944-8984
Mailing Address - Fax:317-944-9760
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:ROOM 5837
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-8984
Practice Address - Fax:317-944-9760
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANA UNIVERSITY SCHOOL OF MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities