Provider Demographics
NPI:1144736737
Name:AGING & DISABLED HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:AGING & DISABLED HOME HEALTH CARE LLC
Other - Org Name:A & D DOC @ HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-260-6145
Mailing Address - Street 1:PO BOX 17460
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-0460
Mailing Address - Country:US
Mailing Address - Phone:800-260-6145
Mailing Address - Fax:888-681-9011
Practice Address - Street 1:10500 CROSSPOINT BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3331
Practice Address - Country:US
Practice Address - Phone:800-260-6145
Practice Address - Fax:888-681-9011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGING & DISABLED HOME HEALTH CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-19
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN170135931208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201284430AMedicaid