Provider Demographics
NPI:1033087291
Name:BABY BOOMER HOME CARE AND GROUP HOME CORP
Entity type:Organization
Organization Name:BABY BOOMER HOME CARE AND GROUP HOME CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DONESHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-201-1655
Mailing Address - Street 1:55 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1427
Mailing Address - Country:US
Mailing Address - Phone:317-201-1655
Mailing Address - Fax:
Practice Address - Street 1:55 E 22ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1427
Practice Address - Country:US
Practice Address - Phone:317-201-1655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health