Provider Demographics
NPI:1336991025
Name:GREENLEAF HOME CARE LLC
Entity Type:Organization
Organization Name:GREENLEAF HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUBUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:FAMOSINPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-993-9681
Mailing Address - Street 1:7273 FARLIN DR
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-9225
Mailing Address - Country:US
Mailing Address - Phone:317-993-9681
Mailing Address - Fax:
Practice Address - Street 1:7273 FARLIN DR
Practice Address - Street 2:
Practice Address - City:WHITESTOWN
Practice Address - State:IN
Practice Address - Zip Code:46075-9225
Practice Address - Country:US
Practice Address - Phone:317-993-9681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care