Provider Demographics
NPI:1770315004
Name:AGING & ACTIVE HOME HEALTH LLC
Entity type:Organization
Organization Name:AGING & ACTIVE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TINESHA
Authorized Official - Middle Name:LAGALE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-497-0594
Mailing Address - Street 1:1111 E 54TH ST STE 170
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3582
Mailing Address - Country:US
Mailing Address - Phone:317-497-0594
Mailing Address - Fax:317-377-4366
Practice Address - Street 1:1111 E 54TH ST STE 170
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3582
Practice Address - Country:US
Practice Address - Phone:317-497-0594
Practice Address - Fax:317-377-4366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health