Provider Demographics
NPI:1689849283
Name:VILLAGES OF INDIANA, INC
Entity type:Organization
Organization Name:VILLAGES OF INDIANA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPIANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-332-1245
Mailing Address - Street 1:2405 N SMITH PIKE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-1363
Mailing Address - Country:US
Mailing Address - Phone:812-332-1245
Mailing Address - Fax:812-333-4717
Practice Address - Street 1:612 E BOULEVARD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-2271
Practice Address - Country:US
Practice Address - Phone:765-455-8545
Practice Address - Fax:765-455-8552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50305 49WW253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200888990 AMedicaid