Provider Demographics
NPI:1770049488
Name:SERVANT HOME CARE
Entity type:Organization
Organization Name:SERVANT HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUANESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:317-480-0415
Mailing Address - Street 1:4035 SUNSHINE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-6724
Mailing Address - Country:US
Mailing Address - Phone:317-480-0415
Mailing Address - Fax:
Practice Address - Street 1:4035 SUNSHINE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-6724
Practice Address - Country:US
Practice Address - Phone:317-480-0415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care