Organization
REM INDIANA
Active
Other names
Indiana Mentor
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT IAN COHEN (COO)
(800) 388-5150
Entity
Organization
Contact information
Practice address
102 OAKTREE CT, LOGANSPORT, IN 46947-4115
(574) 732-1003
Mailing address
9000 KEYSTONE XING STE 200, INDIANAPOLIS, IN 46240-2148
(317) 581-2380
(317) 581-2378
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
2524 B0030DE06
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100239780
PROVIDER NUMBER
IN
Enumeration date
03/13/2007
Last updated
04/19/2023
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