Provider Demographics
NPI:1902547136
Name:CARE ACCESS GROUP, INC-WAIVER SERVICES
Entity Type:Organization
Organization Name:CARE ACCESS GROUP, INC-WAIVER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-213-7975
Mailing Address - Street 1:4151 E 40TH STREET SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-4415
Mailing Address - Country:US
Mailing Address - Phone:317-213-7975
Mailing Address - Fax:
Practice Address - Street 1:4151 E 40TH STREET SOUTH DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-4415
Practice Address - Country:US
Practice Address - Phone:317-213-7975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-03
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities