Provider Demographics
NPI:1275811036
Name:PURE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:PURE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-537-0030
Mailing Address - Street 1:777 E MAIN ST STE 211
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-5300
Mailing Address - Country:US
Mailing Address - Phone:317-537-0030
Mailing Address - Fax:317-876-8293
Practice Address - Street 1:777 E MAIN ST STE 211
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-5300
Practice Address - Country:US
Practice Address - Phone:317-670-0234
Practice Address - Fax:317-876-8293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201083120AMedicaid
IN15-7645Medicare PIN