Provider Demographics
NPI:1437457611
Name:RELIANT@HOME LTD
Entity Type:Organization
Organization Name:RELIANT@HOME LTD
Other - Org Name:RELIANT AT HOME LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:L
Authorized Official - Last Name:PENTICUFF
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:317-674-8453
Mailing Address - Street 1:9301 S POINTE LASALLES DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-9011
Mailing Address - Country:US
Mailing Address - Phone:855-557-6669
Mailing Address - Fax:855-557-3291
Practice Address - Street 1:341 LOGAN ST STE L110
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1610
Practice Address - Country:US
Practice Address - Phone:317-674-8453
Practice Address - Fax:317-674-8703
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PDS MANAGEMENT CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11-012546-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11-012546-1OtherINDIANA STATE DEPARTMENT OF HEALTH LICENSE