Provider Demographics
NPI:1912248220
Name:HOME CARE ASSISTANCE - HOOSIER HEARTLAND INC
Entity Type:Organization
Organization Name:HOME CARE ASSISTANCE - HOOSIER HEARTLAND INC
Other - Org Name:HOME CARE ASSISTANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROTHENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-581-1901
Mailing Address - Street 1:12525 OLD MERIDIAN ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7784
Mailing Address - Country:US
Mailing Address - Phone:317-581-1901
Mailing Address - Fax:
Practice Address - Street 1:12525 OLD MERIDIAN ST
Practice Address - Street 2:SUITE 130
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7784
Practice Address - Country:US
Practice Address - Phone:317-581-1901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12-012946-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201130280 AMedicaid