Provider Demographics
NPI:1467176370
Name:ALTRA HOMECARE GROUP, LLC
Entity Type:Organization
Organization Name:ALTRA HOMECARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-672-6155
Mailing Address - Street 1:7400 N SHADELAND AVE STE 258
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2886
Mailing Address - Country:US
Mailing Address - Phone:317-672-6155
Mailing Address - Fax:317-712-3935
Practice Address - Street 1:7400 N SHADELAND AVE STE 258
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2886
Practice Address - Country:US
Practice Address - Phone:317-672-6155
Practice Address - Fax:317-712-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health