MEDICARE: RAINA R GREEN-SMITH HOME CARE AGENCY

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	251E00000X	Home Health Agency	19-014713-1	IN
2	251E00000X	Home Health Agency	190147131	IN

General Provider Information

NPI Number	:	1245856236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAINA R GREEN-SMITH HOME CARE AGENCY

Provider Business Mailing Address
First Line	:	PO BOX 26165
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-0165
Country	:	US
Telephone Number	:	317-614-5329
Fax Number	:

Provider Business Practice Location Address
First Line	:	4445 N BOLTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-3324
Country	:	US
Telephone Number	:	317-614-5329
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2020
Last Update Date	:	06/25/2020

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