MEDICARE: ROYAL COMFORT HOME CARE

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1295226066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL COMFORT HOME CARE

Provider Business Mailing Address
First Line	:	3670 LACEBARK DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-5600
Country	:	US
Telephone Number	:	317-828-4529
Fax Number	:

Provider Business Practice Location Address
First Line	:	2804 55TH PL STE K
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220
Country	:	US
Telephone Number	:	317-721-8674
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. TONY HUGH MARTIN JR.
Credential	:
Telephone Number	:	317-828-4529

Provider Enumeration Date	:	05/28/2018
Last Update Date	:	07/07/2018

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