Provider Demographics
NPI:1598644494
Name:RATCLIFF, LONZELL ANTHONY
Entity type:Individual
Prefix:
First Name:LONZELL
Middle Name:ANTHONY
Last Name:RATCLIFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11818 HOLZ DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-9629
Mailing Address - Country:US
Mailing Address - Phone:317-981-9175
Mailing Address - Fax:
Practice Address - Street 1:11818 HOLZ DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-9629
Practice Address - Country:US
Practice Address - Phone:317-981-9175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385HR2060X
IN000000385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child