Organization
SUCCESS ACQ CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS JAGODITZ (CHIEF FINANCIAL OFFICER)
(317) 524-6360
Entity
Organization
Contact information
Practice address
3455 WEST VERMONT, INDIANAPOLIS, IN 46222
(317) 916-1402
(317) 630-5221
Mailing address
PO BOX 26456, INDIANAPOLIS, IN 46226
(317) 524-6360
(317) 544-4355
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
43661
IN
Other
Enumeration date
10/03/2006
Last updated
08/22/2020
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