Organization
ECHO PRIME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIELLA MARIE ENCISO (SUPERVISOR)
(317) 565-3777
Entity
Organization
Contact information
Practice address
1520 E 72ND ST BACK, INDIANAPOLIS, IN 46240
(317) 565-3777
Mailing address
1520 E 72ND ST, INDIANAPOLIS, IN 46240-3204
(317) 565-3777
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699427229
—
IN
Enumeration date
07/18/2022
Last updated
07/18/2022
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