Provider Demographics
NPI:1003509597
Name:PROFESSIONAL BURMESE HOME CARE LLC
Entity Type:Organization
Organization Name:PROFESSIONAL BURMESE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-466-0608
Mailing Address - Street 1:6334 BENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7820
Mailing Address - Country:US
Mailing Address - Phone:260-466-0608
Mailing Address - Fax:
Practice Address - Street 1:8356 CROSSER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8254
Practice Address - Country:US
Practice Address - Phone:260-466-0608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care