Provider Demographics
NPI:1750538427
Name:HIGGINS, ROGER LEE JR
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:LEE
Last Name:HIGGINS
Suffix:JR
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 1:6104 W LAKE SOUTH DR
Mailing Address - Street 2:APT A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-7647
Mailing Address - Country:US
Mailing Address - Phone:317-603-2694
Mailing Address - Fax:
Practice Address - Street 1:6104 W LAKE SOUTH DR
Practice Address - Street 2:APT A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-7647
Practice Address - Country:US
Practice Address - Phone:317-603-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities