Provider Demographics
NPI:1992469365
Name:WELLPATH COMMUNITY CARE CENTERS OF INDIANA PC
Entity Type:Organization
Organization Name:WELLPATH COMMUNITY CARE CENTERS OF INDIANA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESCOTEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-246-2202
Mailing Address - Street 1:1283 MURFREESBORO PIKE STE 500
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2421
Mailing Address - Country:US
Mailing Address - Phone:615-258-8631
Mailing Address - Fax:
Practice Address - Street 1:5071 E 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-2863
Practice Address - Country:US
Practice Address - Phone:615-258-8631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder