Provider Demographics
NPI:1619441318
Name:HOME CARE ON DEMAND LLC
Entity Type:Organization
Organization Name:HOME CARE ON DEMAND LLC
Other - Org Name:HOME CARE ON DEMAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:SHARESE
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:317-741-3721
Mailing Address - Street 1:9465 COUNSELORS ROW STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3817
Mailing Address - Country:US
Mailing Address - Phone:317-805-4703
Mailing Address - Fax:317-805-4708
Practice Address - Street 1:9465 COUNSELORS ROW STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-3817
Practice Address - Country:US
Practice Address - Phone:317-805-4703
Practice Address - Fax:317-805-4708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty