1962675561 NPI number — INDIANAPOLIS HOME CARE, INC

Table of content: (NPI 1962675561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962675561 NPI number — INDIANAPOLIS HOME CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANAPOLIS HOME CARE, 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:
INTERIM HEALTHCARE OF INDIANAPOLIS
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:
1962675561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
373 MERIDIAN PARKE LN STE A1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46142-9400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-755-1687
Provider Business Mailing Address Fax Number:
317-992-2266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
373 MERIDIAN PARKE LN STE A1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46142-9400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-755-1687
Provider Business Practice Location Address Fax Number:
317-992-2266
Provider Enumeration Date:
04/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DIMARCO
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
614-436-9404

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  07-006364-2 , 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: 200888320A . This is a "MEDICAID WAIVER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200885920A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".