Provider Demographics
NPI:1750042305
Name:SERVANT HOME HEALTH CARE
Entity Type:Organization
Organization Name:SERVANT HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUANESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-688-8026
Mailing Address - Street 1:2346 S LYNHURST DR STE 606
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-8607
Mailing Address - Country:US
Mailing Address - Phone:317-688-8026
Mailing Address - Fax:
Practice Address - Street 1:2346 S LYNHURST DR STE 606
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-8607
Practice Address - Country:US
Practice Address - Phone:317-688-8026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health