1376817981 NPI number — TPS CAREGIVING LLC

Table of content: (NPI 1376817981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376817981 NPI number — TPS CAREGIVING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TPS CAREGIVING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMFORT KEEPERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376817981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1335 SADLIER CIRCLE EAST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46239-1051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-788-0777
Provider Business Mailing Address Fax Number:
317-780-0767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1335 SADLIER CIRCLE EAST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46239-1051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-788-0777
Provider Business Practice Location Address Fax Number:
317-780-0767
Provider Enumeration Date:
02/28/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PAUL
Authorized Official First Name:
TIM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
317-788-0777

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  13-011960-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 13-011960-1 . This is a "INDIANA STATE DEPARTMENT OF HEALTH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 13-013272-2 . This is a "INDIANA STATE DEPARTMENT OF HEALTH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 201066760A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".