Provider Demographics
NPI:1922469881
Name:INDIANAPOLIS TREATMENT CENTER
Entity Type:Organization
Organization Name:INDIANAPOLIS TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:GALEN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:BATTS
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:317-475-9066
Mailing Address - Street 1:2626 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2380
Mailing Address - Country:US
Mailing Address - Phone:317-475-9066
Mailing Address - Fax:317-257-3602
Practice Address - Street 1:2626 E 46TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2380
Practice Address - Country:US
Practice Address - Phone:317-475-9066
Practice Address - Fax:317-257-3602
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARCADIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-18
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========Medicaid