Provider Demographics
NPI:1083938914
Name:HOME BY CHOICE, LLC
Entity Type:Organization
Organization Name:HOME BY CHOICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-362-4020
Mailing Address - Street 1:1237 N CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-9097
Mailing Address - Country:US
Mailing Address - Phone:765-361-0600
Mailing Address - Fax:765-364-1100
Practice Address - Street 1:1237 N CONCORD RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-9097
Practice Address - Country:US
Practice Address - Phone:765-361-0600
Practice Address - Fax:765-364-1100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABILITIES SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN100122701253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care