Provider Demographics
NPI:1477112324
Name:INDIGO HEALTH CARE,LLC
Entity Type:Organization
Organization Name:INDIGO HEALTH CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:BALLAH
Authorized Official - Last Name:DOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-923-8111
Mailing Address - Street 1:308 2ND ST SE APT 204
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MN
Mailing Address - Zip Code:55369-1532
Mailing Address - Country:US
Mailing Address - Phone:763-923-8111
Mailing Address - Fax:
Practice Address - Street 1:308 2ND ST SE APT 204
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369-1532
Practice Address - Country:US
Practice Address - Phone:763-923-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health