Indiana Developmental Training Center LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

INDIANA DEVELOPMENTAL TRAINING CENTER LLC

Practice address

11075 N Pennsylvania St
Indianapolis, IN 46280

Phone

(317) 815-0505

Fax

(317) 815-1645

NPI assigned

Mar 5, 2007

Organization subpart

No

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

Authorized official

Name

Ms. M Deborah Frisk, MSW

Title

Vice President

Phone

(262) 569-5515

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528197381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 278",
            "city": "DOUSMAN",
            "state": "WI",
            "postal_code": "53118",
            "telephone_number": "262-569-5515",
            "fax_number": "262-569-9962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11075 N PENNSYLVANIA ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46280",
            "telephone_number": "317-815-0505",
            "fax_number": "317-815-1645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA DEVELOPMENTAL TRAINING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FRISK",
        "authorized_official_first_name": "M",
        "authorized_official_middle_name": "DEBORAH",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "262-569-5515",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.