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Organization
CONNIE'S CLUBHOUSE
Active
Organization
CONNIE'S CLUBHOUSE
Active
Other names
Connie's Clubhoues Inc
Organization subpart
No
Provider details
NPI number
Authorized official
TAYLOR HINES MIRANDA (EXECUTIVE DIRECTOR)
(435) 621-4153
Entity
Organization
Contact information
Practice address
5142 MADISON AVE STE 7, INDIANAPOLIS, IN 46227-4248
(435) 621-4153
Mailing address
5142 MADISON AVE STE 7, INDIANAPOLIS, IN 46227-4248
(435) 621-4153
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261Q00000X
Clinic/Center
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
07/01/2025
Last updated
03/19/2026
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