Indiana Fair Chance Llc

LBN: Indiana Fair Chance Llc
Indiana Fair Chance Llc is an health care organization with primary practice located at 7437 Cobblestone East Dr , Indianapolis IN 46236-9108. The organization recently has only one registered license in Agencies / Case Management, which is considered as the primary health care specialty. Indiana Fair Chance Llc can be contacted via phone (317) 418-7840, or through Bullock, Mary Jean via phone (317) 418-7840.

Contact Information

Primary practice address
7437 Cobblestone East Dr Indianapolis IN 46236-9108
Phone: (317) 418-7840
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Bullock, Mary Jean LSW MBA
Phone: (317) 418-7840

Health care specialties

SpecialtyCodeLicense #State
Agencies / Case Management 251B00000X

Profile Details

NPI number 1235494006
LBN Legal business name Indiana Fair Chance Llc
DBA Doing business as
Authorized official Bullock, Mary Jean LSW MBA
Entity Organization
Organization subpart 1 No
Enumeration date Jul 9th, 2012
Last updated Jul 9th, 2012 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235494006 NPPES
Indiana Other 201068830 A WAIVER PROVIDER

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