MEDICARE: DOUBLEGMESSIAH 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	374U00000X	Home Health Aide
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1770264418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUBLEGMESSIAH HOME CARE

Provider Business Mailing Address
First Line	:	1246 COUNTRY RIDGE LN # 12
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-3803
Country	:	US
Telephone Number	:	443-657-0194
Fax Number	:

Provider Business Practice Location Address
First Line	:	1246 COUNTRY RIDGE LN # 12
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-3803
Country	:	US
Telephone Number	:	443-657-0194
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. GRACE F OBIDIRAN
Credential	:
Telephone Number	:	443-657-0194

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	07/26/2023

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