Provider Demographics
NPI:1952790354
Name:PEACE A FAITH-BASED SUBSTANCE ABUSE PROGRAM
Entity Type:Organization
Organization Name:PEACE A FAITH-BASED SUBSTANCE ABUSE PROGRAM
Other - Org Name:P.E.A.C.E., LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCAC
Authorized Official - Phone:317-412-9737
Mailing Address - Street 1:5401 S EAST ST
Mailing Address - Street 2:SUITE 205-C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2064
Mailing Address - Country:US
Mailing Address - Phone:317-412-9737
Mailing Address - Fax:317-489-6089
Practice Address - Street 1:5401 S EAST ST
Practice Address - Street 2:SUITE 205-C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2064
Practice Address - Country:US
Practice Address - Phone:317-412-9737
Practice Address - Fax:317-489-6089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 104100000X
IN87000715A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty