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EAST INDIANA TREATMENT CENTER, LLC

Ambulatory Health Care Facilities Clinic/Center Rehabilitation, Substance Use Disorder

Provider NPI: 1013060714

Organization Information:
Organization Name:  EAST INDIANA TREATMENT CENTER, LLC
Organization is Subpart
Authorized Official:  PETER F MORRIS  PRESIDENT, CTC DIVISION  615-721-1297

Practice Location:
816 RUDOLPH WAY  GREENDALE, IN 47025-8312 US
Tel: 812-537-1668  Fax: 812-537-1625

Business Mailing Address:
6185 PASEO DEL NORTE STE 150  CARLSBAD, CA 92011-1155 US
Tel: 760-710-0819  Fax: 812-539-2368

NPI Information:
NPI: 1013060714
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N261QR0405XAmbulatory Health Care Facilities
Clinic/Center
Rehabilitation, Substance Use Disorder
IN10780ASR
N261Q00000XAmbulatory Health Care Facilities
Clinic/Center
IN10780ASR
Y261QM2800XAmbulatory Health Care Facilities
Clinic/Center
IN10780ASR

Other Provider Identifiers:

IssuerNumberStateType
0279713OH05
201345410AIN05
3000012052IN05



American Medical Association 2012 taxonomy code information

Code: 261QM2800X

Type:

Classification:



Definition:



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