Provider Demographics
NPI:1710308275
Name:LARRIS-IFY HOMECARE
Entity Type:Organization
Organization Name:LARRIS-IFY HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:OMLARA
Authorized Official - Last Name:DILIBE-YESSOUFOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-672-9284
Mailing Address - Street 1:5445 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-1643
Mailing Address - Country:US
Mailing Address - Phone:317-672-9284
Mailing Address - Fax:317-875-1628
Practice Address - Street 1:5445 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1643
Practice Address - Country:US
Practice Address - Phone:317-672-9284
Practice Address - Fax:317-875-1628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health