Provider Demographics
NPI:1447401138
Name:COMMUNITY CHOICE HEALTH CARE PC
Entity Type:Organization
Organization Name:COMMUNITY CHOICE HEALTH CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MR
Authorized Official - First Name:OSADEBAMWEN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:OMOROGBE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:317-457-1184
Mailing Address - Street 1:5722 SKIPPING STONE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-5056
Mailing Address - Country:US
Mailing Address - Phone:317-457-1184
Mailing Address - Fax:
Practice Address - Street 1:5722 SKIPPING STONE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-5056
Practice Address - Country:US
Practice Address - Phone:317-457-1184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health