MEDICARE: IRIS HOME AND PERSONAL 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1720821051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRIS HOME AND PERSONAL CARE LLC

Provider Business Mailing Address
First Line	:	7740 COLE WOOD BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-7780
Country	:	US
Telephone Number	:	317-675-9003
Fax Number	:

Provider Business Practice Location Address
First Line	:	7740 COLE WOOD BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-7780
Country	:	US
Telephone Number	:	317-675-9003
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LASHONA LEE
Credential	:	HHA,CMA
Telephone Number	:	317-201-2340

Provider Enumeration Date	:	06/14/2024
Last Update Date	:	06/14/2024

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