Provider Demographics
NPI:1689979965
Name:SELECT HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:SELECT HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:RADICS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-787-1570
Mailing Address - Street 1:650 E CARMEL DR STE 400
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2867
Mailing Address - Country:US
Mailing Address - Phone:317-804-8996
Mailing Address - Fax:
Practice Address - Street 1:650 E CARMEL DR STE 400
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2867
Practice Address - Country:US
Practice Address - Phone:317-804-8996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11-012550-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
157635Medicare Oscar/Certification