Provider Demographics
NPI:1811347651
Name:ASSURANCE HEALTH INDIANAPOLIS, LLC
Entity type:Organization
Organization Name:ASSURANCE HEALTH INDIANAPOLIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:317-870-1396
Mailing Address - Street 1:8465 KEYSTONE XING
Mailing Address - Street 2:SUITE 210
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-4355
Mailing Address - Country:US
Mailing Address - Phone:317-870-1396
Mailing Address - Fax:317-757-8491
Practice Address - Street 1:900 N HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3759
Practice Address - Country:US
Practice Address - Phone:317-982-3715
Practice Address - Fax:317-481-0547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1749-1-PIPOtherSTATE LICENSE
IN154064Medicare Oscar/Certification