Provider Demographics
NPI:1275608713
Name:CICOA AGING & IN HOME SOLUTIONS INC
Entity Type:Organization
Organization Name:CICOA AGING & IN HOME SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAUHRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-803-6010
Mailing Address - Street 1:8440 WOODFIELD CROSSING BLVD STE 175
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-4359
Mailing Address - Country:US
Mailing Address - Phone:317-254-5465
Mailing Address - Fax:317-254-5494
Practice Address - Street 1:8440 WOODFIELD CROSSING BLVD STE 175
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-4359
Practice Address - Country:US
Practice Address - Phone:317-254-5465
Practice Address - Fax:317-254-5494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133NN1002X, 133V00000X, 133VN1005X, 133VN1006X, 133VN1101X, 133VN1201X, 171M00000X
IN171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, GerontologicalGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100107990AMedicaid