Organization Name: | EAST INDIANA TREATMENT CENTER |
NPI Number: | 1013060714 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARY ANN DETMER (CLINIC DIRECTOR) |
Mailing Address: | 816 Rudolph Way Greendale |
State: | IN US |
Postal Code: | 470258312 |
Phone Number: | 8125371668 |
Fax Number: | 8125392368 |
NPI Enumeration Date: | 01/18/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM2800X |
License Number: | 10780ASR |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | IN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Methadone Clinic |
Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. |