1437457611 NPI number — RELIANT@HOME LTD

Table of content: (NPI 1437457611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437457611 NPI number — RELIANT@HOME LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIANT@HOME LTD
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:
1437457611
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9301 S POINTE LASALLES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47401-9011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-557-6669
Provider Business Mailing Address Fax Number:
855-557-3291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
341 LOGAN ST STE L110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOBLESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46060-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-674-8453
Provider Business Practice Location Address Fax Number:
317-674-8703
Provider Enumeration Date:
03/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PENTICUFF
Authorized Official First Name:
SHARI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR/DIRECTOR
Authorized Official Telephone Number:
317-674-8453

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  11-012546-1 , 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: 11-012546-1 . This is a "INDIANA STATE DEPARTMENT OF HEALTH LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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