Provider Demographics
NPI:1780055053
Name:EAST INDIANA COMPREHENSIVE TREATMENT CENTER
Entity type:Organization
Organization Name:EAST INDIANA COMPREHENSIVE TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVY
Authorized Official - Middle Name:RUFINA
Authorized Official - Last Name:VOYNOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MS LCDC III
Authorized Official - Phone:812-537-1668
Mailing Address - Street 1:816 RUDOLPH WAY
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:IN
Mailing Address - Zip Code:47025-8312
Mailing Address - Country:US
Mailing Address - Phone:812-537-1668
Mailing Address - Fax:812-537-9173
Practice Address - Street 1:816 RUDOLPH WAY
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:IN
Practice Address - Zip Code:47025-8312
Practice Address - Country:US
Practice Address - Phone:812-537-1668
Practice Address - Fax:812-537-9173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACADIA HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH081062251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health