Provider Demographics
NPI:1487053260
Name:ASSURANCE HEALTH, LLC
Entity type:Organization
Organization Name:ASSURANCE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-870-1396
Mailing Address - Street 1:8465 KEYSTONE XING
Mailing Address - Street 2:SUITE 210
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-4355
Mailing Address - Country:US
Mailing Address - Phone:317-870-1396
Mailing Address - Fax:317-757-8491
Practice Address - Street 1:2725 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-9670
Practice Address - Country:US
Practice Address - Phone:765-374-6044
Practice Address - Fax:765-374-6043
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSURANCE HEALTH SYSTEM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-18
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1699-1-PIP283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1699-1-PIPOtherSTATE OF INDIANA
IN201292260AMedicaid
IN1699-1-PIPOtherSTATE OF INDIANA