Provider Demographics
NPI:1124753868
Name:ECHO PRIME LLC
Entity type:Organization
Organization Name:ECHO PRIME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LIELLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ENCISO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-565-3777
Mailing Address - Street 1:1520 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3204
Mailing Address - Country:US
Mailing Address - Phone:317-565-3777
Mailing Address - Fax:
Practice Address - Street 1:1520 E 72ND ST BACK
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240
Practice Address - Country:US
Practice Address - Phone:317-565-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1699427229Medicaid