Provider Demographics
NPI:1891394813
Name:INDICARE HOME HEALTH LLC
Entity Type:Organization
Organization Name:INDICARE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ISHEEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BULTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-968-1600
Mailing Address - Street 1:1406 FORT CROOK RD S STE 410
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-2980
Mailing Address - Country:US
Mailing Address - Phone:402-968-1600
Mailing Address - Fax:
Practice Address - Street 1:1406 FORT CROOK RD S STE 410
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-2980
Practice Address - Country:US
Practice Address - Phone:402-968-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health