Provider Demographics
NPI:1639430044
Name:GARLANDA HATTER
Entity Type:Organization
Organization Name:GARLANDA HATTER
Other - Org Name:LIBERTY LIVING HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HATTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-652-0482
Mailing Address - Street 1:7710 TARDELLI LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-2358
Mailing Address - Country:US
Mailing Address - Phone:317-652-0482
Mailing Address - Fax:
Practice Address - Street 1:7710 TARDELLI LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-2358
Practice Address - Country:US
Practice Address - Phone:317-652-0482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARLANDA HATTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12-01284-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care