Provider Demographics
NPI:1700241528
Name:BROTHERS UNITED, INC.
Entity type:Organization
Organization Name:BROTHERS UNITED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:JIMISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:317-931-0292
Mailing Address - Street 1:3737 N MERIDIAN ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4347
Mailing Address - Country:US
Mailing Address - Phone:317-931-0292
Mailing Address - Fax:317-931-0294
Practice Address - Street 1:3737 N MERIDIAN ST
Practice Address - Street 2:SUITE 401
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4347
Practice Address - Country:US
Practice Address - Phone:317-931-0292
Practice Address - Fax:317-931-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder