Provider Demographics
NPI:1275846909
Name:PEDIATRIC PLUS HOME HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:PEDIATRIC PLUS HOME HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-284-2824
Mailing Address - Street 1:925 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-4209
Mailing Address - Country:US
Mailing Address - Phone:812-284-2824
Mailing Address - Fax:812-920-0163
Practice Address - Street 1:925 MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4209
Practice Address - Country:US
Practice Address - Phone:812-284-2824
Practice Address - Fax:812-920-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10-012370-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201019310AMedicaid
IN201008780AMedicaid