Indiana Fair Chance LLC

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

INDIANA FAIR CHANCE LLC

Practice address

7437 Cobblestone East Dr
Indianapolis, IN 46236-9108

Phone

(317) 418-7840

NPI assigned

Jul 9, 2012

Last updated

Jul 9, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Mary Jean Bullock, LSW MBANPI 1437553989

Title

Manager

Phone

(317) 418-7840

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary Bullock

  • Case Manager/Care Coordinator
  • Indianapolis, IN
  • NPI 1437553989
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341792000000",
    "number": "1235494006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7437 COBBLESTONE EAST DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462369108",
            "telephone_number": "317-418-7840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7437 COBBLESTONE EAST DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462369108",
            "telephone_number": "317-418-7840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA FAIR CHANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-09",
        "last_updated": "2012-07-09",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "317-418-7840",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LSW MBA"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WAIVER PROVIDER",
            "identifier": "201068830 A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Indiana Emergency Dental Fishers LLC (Indiana Emergency Dental)
• Indiana Emergency Solutions LLC
• Indiana Endodontics
• Indiana Endoscopy Centers LLC (Indiana Endoscopy Center)
• Indiana Eyecare Center PC (Indiana EyeCare Center)
• Indiana Family Health Council, Inc.
• Indiana Family Home Care, LLC
• Indiana Fertility Associates, PC
• Indiana Fertility Laboratory LLC
• Indiana Fitness Works Inc

• Case Management Agency in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Case Management Agency in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.