Provider Demographics
NPI:1508098823
Name:HOME CARE HOME INC.
Entity Type:Organization
Organization Name:HOME CARE HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LARGE
Authorized Official - Suffix:
Authorized Official - Credentials:ASSOC NURSING/BUSIN
Authorized Official - Phone:812-574-2273
Mailing Address - Street 1:975 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-3904
Mailing Address - Country:US
Mailing Address - Phone:812-574-2273
Mailing Address - Fax:812-574-2274
Practice Address - Street 1:975 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-3904
Practice Address - Country:US
Practice Address - Phone:812-574-2273
Practice Address - Fax:812-574-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN090121831253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care