Provider Demographics
NPI:1174317143
Name:INDY TEEN TREATMENT CENTER LLC
Entity type:Organization
Organization Name:INDY TEEN TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-372-6480
Mailing Address - Street 1:1451 ROUTE 88 STE 5
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2371
Mailing Address - Country:US
Mailing Address - Phone:845-372-6480
Mailing Address - Fax:
Practice Address - Street 1:6620 PARKDALE PL STE N
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4697
Practice Address - Country:US
Practice Address - Phone:845-372-6480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility