MEDICARE: FRUITOFTHESPIRITLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	372600000X	Adult Companion
2	374U00000X	Home Health Aide
3	376J00000X	Homemaker
4	376K00000X	Nurse's Aide
5	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1649088311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRUITOFTHESPIRITLLC

Provider Business Mailing Address
First Line	:	5437 FALLWOOD DR APT 115
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-5657
Country	:	US
Telephone Number	:	317-444-9057
Fax Number	:

Provider Business Practice Location Address
First Line	:	5437 FALLWOOD DR APT 115
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-5657
Country	:	US
Telephone Number	:	317-444-9057
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS EBONY DAVIS
Credential	:
Telephone Number	:	317-444-9057

Provider Enumeration Date	:	12/26/2024
Last Update Date	:	12/26/2024

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Directions to “FRUITOFTHESPIRITLLC ” Practice Location

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