Provider Demographics
NPI:1083359277
Name:PRIMECARE HOME CARE SERVICES OF INDIANA, LLC
Entity Type:Organization
Organization Name:PRIMECARE HOME CARE SERVICES OF INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOURNOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-904-4276
Mailing Address - Street 1:8063 MADISON AVE # 1035
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6001
Mailing Address - Country:US
Mailing Address - Phone:317-559-6062
Mailing Address - Fax:317-559-4362
Practice Address - Street 1:8945 N MERIDIAN ST STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5390
Practice Address - Country:US
Practice Address - Phone:317-559-6062
Practice Address - Fax:317-559-4362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty