NPIMap

Organization Active NPI

Shore Behavioral LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Indianapolis, IN
National Provider Identifier
1457022865
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
SHORE BEHAVIORAL LLC
Practice address
4102 Shore Dr
Indianapolis, IN 46254-2608
Phone
(513) 489-7100
NPI assigned
Sep 24, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2025

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

Authorized official

Name
Yitzchak Rosedale
Title
President
Phone
(513) 530-1808

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

4102 Shore Dr
Indianapolis, IN 46254-2608

Mailing address

10123 Alliance Rd
Blue Ash, OH 45242-4887
Phone (513) 530-1808

Other names 1

  • Ethan Crossing Addiction Campus of Indianapolis Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Shore Behavioral LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1632441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746057600000",
    "number": "1457022865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10123 ALLIANCE RD",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452424887",
            "telephone_number": "513-530-1808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4102 SHORE DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462542608",
            "telephone_number": "513-489-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE BEHAVIORAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-24",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A",
        "authorized_official_last_name": "ROSEDALE",
        "authorized_official_first_name": "YITZCHAK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "513-530-1808"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ethan Crossing Addiction Campus of Indianapolis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2025; 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.