MEDICARE: DELLAVENIA'S HOME CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1114743754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELLAVENIA'S HOME CARE, LLC

Provider Business Mailing Address
First Line	:	3657 REFLECTIONS LN UNIT 6
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-5104
Country	:	US
Telephone Number	:	469-406-2217
Fax Number	:

Provider Business Practice Location Address
First Line	:	3657 REFLECTIONS LN UNIT 6
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-5104
Country	:	US
Telephone Number	:	469-406-2217
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	SHAUNDELL PACE
Credential	:
Telephone Number	:	469-406-2217

Provider Enumeration Date	:	11/27/2024
Last Update Date	:	12/23/2024

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