1073897070 NPI number — RELIABLE PERSONAL CARE SERVICES, LLC

Table of content: (NPI 1073897070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073897070 NPI number — RELIABLE PERSONAL CARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIABLE PERSONAL CARE SERVICES, 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:
Provider Other Organization Name Type Code:
6
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:
1073897070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2141 N FRANKLIN RD
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:
46219-2435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-375-8530
Provider Business Mailing Address Fax Number:
317-894-9887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2141 N FRANKLIN RD
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:
46219-2435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-375-8530
Provider Business Practice Location Address Fax Number:
317-894-9887
Provider Enumeration Date:
10/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CLAYTON
Authorized Official First Name:
ERRON
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
317-375-8530

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  13-012999-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 11-012074-1 , 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: 12-012074-1 . This is a "INDIANA STATE DEPARTMENT OF HEALTH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 12-012999-1 . This is a "INDIANA STATE DEPARTMENT OF HEALTH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 15D2044947 . This is a "CLIA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200930770 . This is a "LPI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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