Provider Demographics
NPI:1770836652
Name:INDIANA HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:INDIANA HOME CARE SERVICES LLC
Other - Org Name:PREMIER HOMECARE OF INDIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-536-1731
Mailing Address - Street 1:8455 KEYSTONE XING
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-4353
Mailing Address - Country:US
Mailing Address - Phone:317-536-1731
Mailing Address - Fax:463-212-8855
Practice Address - Street 1:8455 KEYSTONE XING
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-4353
Practice Address - Country:US
Practice Address - Phone:317-536-1731
Practice Address - Fax:463-212-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120125811251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN120125811OtherINDIANA STATE LICENSURE