Provider Demographics
NPI:1376260489
Name:INDEPENDENCE PERSONAL CARE LLC
Entity Type:Organization
Organization Name:INDEPENDENCE PERSONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:317-954-8328
Mailing Address - Street 1:8282 S NINEVEH RD
Mailing Address - Street 2:
Mailing Address - City:NINEVEH
Mailing Address - State:IN
Mailing Address - Zip Code:46164-9705
Mailing Address - Country:US
Mailing Address - Phone:317-933-3310
Mailing Address - Fax:317-933-3311
Practice Address - Street 1:8282 S NINEVEH RD
Practice Address - Street 2:
Practice Address - City:NINEVEH
Practice Address - State:IN
Practice Address - Zip Code:46164-9705
Practice Address - Country:US
Practice Address - Phone:317-933-3310
Practice Address - Fax:317-933-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201134950AMedicaid