Provider Demographics
NPI:1134966427
Name:THOMAS, JAMES DEWAYNE (CEO/OWNER)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DEWAYNE
Last Name:THOMAS
Suffix:
Gender:
Credentials:CEO/OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 LONG IRON DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-5003
Mailing Address - Country:US
Mailing Address - Phone:888-239-8911
Mailing Address - Fax:
Practice Address - Street 1:4735 LONG IRON DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-5003
Practice Address - Country:US
Practice Address - Phone:888-239-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN240173741251E00000X, 253Z00000X
3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300098781Medicaid