Provider Demographics
NPI:1558870550
Name:EVANSVILLE IN HOMECARE, LLC
Entity Type:Organization
Organization Name:EVANSVILLE IN HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-213-6882
Mailing Address - Street 1:123 NW 4TH ST STE 312
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1712
Mailing Address - Country:US
Mailing Address - Phone:812-213-6882
Mailing Address - Fax:
Practice Address - Street 1:123 NW 4TH ST STE 312
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708
Practice Address - Country:US
Practice Address - Phone:812-213-6882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-22
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17-014108-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care