Provider Demographics
NPI:1437755519
Name:CROWN PERSONAL CARE AGENCY
Entity Type:Organization
Organization Name:CROWN PERSONAL CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COMFORT
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-223-5648
Mailing Address - Street 1:10890 POPPY HILL DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-1251
Mailing Address - Country:US
Mailing Address - Phone:317-223-5648
Mailing Address - Fax:
Practice Address - Street 1:10890 POPPY HILL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-1251
Practice Address - Country:US
Practice Address - Phone:317-223-5648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty