Organization
COACH DREAMMAKERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICKY BUCKLEY (OWNER)
(317) 513-2386
Entity
Organization
Contact information
Practice address
5626 PORTWOOD PL, INDIANAPOLIS, IN 46254-5140
(317) 513-2386
Mailing address
5626 PORTWOOD PL, INDIANAPOLIS, IN 46254-5140
(317) 513-2386
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2330496686
IN
Other
Enumeration date
11/13/2014
Last updated
11/13/2014
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