MEDICARE: TEASPOON OF NURTURING TOUCH HOMECARE AGENCY, 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1124718812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEASPOON OF NURTURING TOUCH HOMECARE AGENCY, LLC

Provider Business Mailing Address
First Line	:	1983 WOODCOCK DR
Second Line	:
City	:	AVON
State	:	IN
Zip	:	46123-7554
Country	:	US
Telephone Number	:	317-523-8918
Fax Number	:

Provider Business Practice Location Address
First Line	:	2402 DR ANDREW J BROWN AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-4457
Country	:	US
Telephone Number	:	317-523-8918
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KE'TRE LAWAII DICKENS
Credential	:
Telephone Number	:	317-523-8918

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/08/2023

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