Organization
LIVING HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAM A ADEYANJU MS (CEO)
(317) 291-9388
Entity
Organization
Contact information
Practice address
6350 WESTHAVEN DR STE F, INDIANAPOLIS, IN 46254-2731
(317) 291-9388
(317) 291-9389
Mailing address
6350 WESTHAVEN DR STE F, INDIANAPOLIS, IN 46254-2731
(317) 291-9388
(317) 291-9389
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
07/30/2012
Last updated
07/30/2012
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