MEDICARE: AT HOME- HOME CARE SERVICES, 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	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750467379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT HOME- HOME CARE SERVICES, LLC.

Provider Business Mailing Address
First Line	:	6201 LA PAS TRL
Second Line	:	SUITE 170
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-4887
Country	:	US
Telephone Number	:	317-396-1573
Fax Number	:	317-297-7895

Provider Business Practice Location Address
First Line	:	6201 LA PAS TRL
Second Line	:	SUITE 170
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-4887
Country	:	US
Telephone Number	:	317-396-1573
Fax Number	:	317-297-7895

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	RICK JOHNSON
Credential	:
Telephone Number	:	317-396-1573

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	08/30/2007

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