Provider Demographics
NPI:1043496060
Name:KOKOMO ACADEMY
Entity type:Organization
Organization Name:KOKOMO ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:317-274-1359
Mailing Address - Street 1:900 KEYSTONE CROSSING
Mailing Address - Street 2:STE 1040
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240
Mailing Address - Country:US
Mailing Address - Phone:317-694-4074
Mailing Address - Fax:
Practice Address - Street 1:623 S BERKLEY RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-5150
Practice Address - Country:US
Practice Address - Phone:765-452-9989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORRECTIONAL MANAGEMENT COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty