Provider Demographics
NPI:1427061407
Name:SERVICE ABOVE SELF, LLC
Entity type:Organization
Organization Name:SERVICE ABOVE SELF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:O
Authorized Official - Last Name:NWAKA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:317-541-1836
Mailing Address - Street 1:3919 MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-3113
Mailing Address - Country:US
Mailing Address - Phone:317-541-1836
Mailing Address - Fax:317-541-1858
Practice Address - Street 1:3919 MEADOWS DR
Practice Address - Street 2:BOX 421441
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3113
Practice Address - Country:US
Practice Address - Phone:317-541-1836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200427340Medicaid