Provider Demographics
NPI:1710170220
Name:VETRA DAVIS
Entity Type:Organization
Organization Name:VETRA DAVIS
Other - Org Name:VETRA DAVIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VETRA
Authorized Official - Middle Name:LEFAYE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-529-5400
Mailing Address - Street 1:5960 MANNING RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-1081
Mailing Address - Country:US
Mailing Address - Phone:317-529-5400
Mailing Address - Fax:
Practice Address - Street 1:5960 MANNING RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-1081
Practice Address - Country:US
Practice Address - Phone:317-529-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health