Provider Demographics
NPI:1508622218
Name:CAMPBELL, SCHARITY SHENELLE (CEO)
Entity Type:Individual
Prefix:MS
First Name:SCHARITY
Middle Name:SHENELLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 COLLINWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-2033
Mailing Address - Country:US
Mailing Address - Phone:317-439-5637
Mailing Address - Fax:
Practice Address - Street 1:6333 HOLLISTER DR STE B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-2918
Practice Address - Country:US
Practice Address - Phone:317-403-3997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22-015723376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker