NORMAL LIFE OF INDIANA NPI 1689792574

NPI Information

NPI: 1689792574
Provider Name: NORMAL LIFE OF INDIANA

Other Name: WAGGONER

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
3512 WAGGONER AVE
EVANSVILLE, IN
ZIP 47714
Phone: (812) 433-3535
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NORMAL LIFE OF INDIANA is an intermediate care facility mentally retarded in Evansville, IN. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. NORMAL LIFE OF INDIANA NPI is 1689792574. The provider is registered as an organization entity type.
The provider Other Name Is Waggoner.

The provider's business location address is:

3512 WAGGONER AVE
EVANSVILLE, IN
ZIP 47714-463
Phone: (812) 433-3535

The provider's authorized official is Deena Ombres .
The authorized official title is Privacy Officer and has the following contact phone number (502) 394-2387.

The enumeration date for this NPI number is 3/27/2007 and was last updated on 7/16/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100234400A	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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