Organization
NORMAL LIFE OF INDIANA
Active
Other names
EVANS RIVERSIDE
Organization subpart
No
Provider details
NPI number
Authorized official
DENISHA CONNOR (PROVIDER ENROLLMENT)
(502) 630-7421
Entity
Organization
Contact information
Practice address
3913 E RIVERSIDE DR, EVANSVILLE, IN 47714-6446
(812) 433-3535
Mailing address
805 N WHITTINGTON PKWY, LOUISVILLE, KY 40222-7101
(800) 866-0860
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100235170A
—
IN
Enumeration date
03/28/2007
Last updated
11/26/2024
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