Organization
INDY DEVELOPMENTAL RESIDENTIAL SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLEEN ROBERTSON (OWNER)
(317) 970-3880
Entity
Organization
Contact information
Practice address
1121 N RURAL ST, INDIANAPOLIS, IN 46201-1328
(317) 970-3880
Mailing address
1121 N RURAL ST, INDIANAPOLIS, IN 46201-1328
(317) 970-3880
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/04/2020
Last updated
12/04/2020
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