Provider Demographics
NPI:1194107698
Name:EMERALD CITY BEHAVIOR CENTER
Entity type:Organization
Organization Name:EMERALD CITY BEHAVIOR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-701-0508
Mailing Address - Street 1:12684 ADIRONDACK CT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4274
Mailing Address - Country:US
Mailing Address - Phone:317-504-8330
Mailing Address - Fax:
Practice Address - Street 1:6809 PERCY DR
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-7601
Practice Address - Country:US
Practice Address - Phone:317-701-0508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health