Provider Demographics
NPI:1700516531
Name:FRUIT OF THE SPIRIT, INC
Entity Type:Organization
Organization Name:FRUIT OF THE SPIRIT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-600-5019
Mailing Address - Street 1:4707 BLUE MARLIN WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-7928
Mailing Address - Country:US
Mailing Address - Phone:317-835-3344
Mailing Address - Fax:
Practice Address - Street 1:4707 BLUE MARLIN WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-7928
Practice Address - Country:US
Practice Address - Phone:317-835-3344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)