Basic Information
| Provider Information | |||||||||
| NPI: | 1710105002 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADULT AND CHILD CENTER, INC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8320 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462276066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178825122 | ||||||||
| FaxNumber: | 3178888642 | ||||||||
| Practice Location | |||||||||
| Address1: | 8320 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462276066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178825122 | ||||||||
| FaxNumber: | 3178888642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 04/01/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BREYER | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3178930310 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.