Provider Demographics
NPI:1619581741
Name:SANCTUARY HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:SANCTUARY HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-247-0837
Mailing Address - Street 1:1048B SAGAMORE PKWY W # 1011
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1446
Mailing Address - Country:US
Mailing Address - Phone:765-247-0837
Mailing Address - Fax:765-478-7005
Practice Address - Street 1:1048B SAGAMORE PKWY W # 1011
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1446
Practice Address - Country:US
Practice Address - Phone:765-247-0837
Practice Address - Fax:765-478-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-05
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1083231823OtherHOME CARE AGENCY