Provider Demographics
NPI:1720691504
Name:TEAM HOPE OF INDIANA LLC
Entity Type:Organization
Organization Name:TEAM HOPE OF INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAVARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SUGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-804-3637
Mailing Address - Street 1:3121 EVERBLOOM WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-9136
Mailing Address - Country:US
Mailing Address - Phone:260-804-3637
Mailing Address - Fax:
Practice Address - Street 1:3121 EVERBLOOM WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-9136
Practice Address - Country:US
Practice Address - Phone:260-804-3637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty