Provider Demographics
NPI:1003446550
Name:INDEPENDENT ADULT DAY CARE CENTERS OF INDIANA - SHELBY STREET
Entity type:Organization
Organization Name:INDEPENDENT ADULT DAY CARE CENTERS OF INDIANA - SHELBY STREET
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPICCOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-296-8815
Mailing Address - Street 1:2225 SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-4260
Mailing Address - Country:US
Mailing Address - Phone:317-296-8815
Mailing Address - Fax:
Practice Address - Street 1:2225 SHELBY ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-4260
Practice Address - Country:US
Practice Address - Phone:317-296-8815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENDENT ADULT DAY CARE CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-23
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No253Z00000XAgenciesIn Home Supportive Care