Provider Demographics
NPI:1073204038
Name:A SUPPORTIVE CARE OF INDY LLC
Entity Type:Organization
Organization Name:A SUPPORTIVE CARE OF INDY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRUSSANA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-629-2235
Mailing Address - Street 1:5102 ANGELIQUE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5762
Mailing Address - Country:US
Mailing Address - Phone:317-629-2235
Mailing Address - Fax:
Practice Address - Street 1:5102 ANGELIQUE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5762
Practice Address - Country:US
Practice Address - Phone:317-629-2235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care