Provider Demographics
NPI:1376354530
Name:HOME STAY LLC
Entity type:Organization
Organization Name:HOME STAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-792-0223
Mailing Address - Street 1:1040 E 86TH ST STE 46C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1857
Mailing Address - Country:US
Mailing Address - Phone:317-792-0223
Mailing Address - Fax:
Practice Address - Street 1:HOMESTAY HOME CARE
Practice Address - Street 2:1839 ROBIN RD SUITE 106
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-3040
Practice Address - Country:US
Practice Address - Phone:317-792-0223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care