1538469051 NPI number — HOME HEALTH DEPOT INC

Table of content: (NPI 1538469051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538469051 NPI number — HOME HEALTH DEPOT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME HEALTH DEPOT INC
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:
Provider Other Organization Name Type Code:
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:
1538469051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9245 N MERIDIAN ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46260-1836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-333-6033
Provider Business Mailing Address Fax Number:
317-333-6034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2228 SAGAMORE PKWY S
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47905-5112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-807-5628
Provider Business Practice Location Address Fax Number:
765-807-5640
Provider Enumeration Date:
10/31/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDMAN
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF CONTRACTING
Authorized Official Telephone Number:
317-333-6033

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  69000636A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: 69000636A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 69000636A , 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: 200206500E , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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