Provider Demographics
NPI:1720447279
Name:INDIGO HEALTHCARE LLC
Entity Type:Organization
Organization Name:INDIGO HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-915-6395
Mailing Address - Street 1:12929 LA ROCHELLE CIR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1406
Mailing Address - Country:US
Mailing Address - Phone:941-915-6395
Mailing Address - Fax:
Practice Address - Street 1:1693 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5864
Practice Address - Country:US
Practice Address - Phone:941-915-6395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW105741041C0700X
FLME603272084B0040X
FLARNP9245432251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty