Provider Demographics
NPI:1790978039
Name:RETRO HOME HEALTH CARE SERVICES,LLC
Entity Type:Organization
Organization Name:RETRO HOME HEALTH CARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-270-7117
Mailing Address - Street 1:4084 PENDLETON WAY
Mailing Address - Street 2:PMB 172
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-5224
Mailing Address - Country:US
Mailing Address - Phone:317-270-7117
Mailing Address - Fax:317-869-0982
Practice Address - Street 1:4084 PENDLETON WAY
Practice Address - Street 2:PMB 172
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-5224
Practice Address - Country:US
Practice Address - Phone:317-270-7117
Practice Address - Fax:317-869-0982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN25100000XMedicaid