Provider Demographics
NPI:1013501675
Name:PADRON, PATRICE (ADMINISTRATOR)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:PADRON
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 S STATE AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-3802
Mailing Address - Country:US
Mailing Address - Phone:317-682-7394
Mailing Address - Fax:
Practice Address - Street 1:55 S STATE AVE STE 210
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-3802
Practice Address - Country:US
Practice Address - Phone:317-682-7394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
373H00000X, 171M00000X
IN376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No376K00000XNursing Service Related ProvidersNurse's Aide