MEDICARE: AGE IN PLACE HOME 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	253Z00000X	In Home Supportive Care Agency	16-013923-1	IN
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1770932915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGE IN PLACE HOME SERVICES LLC

Provider Business Mailing Address
First Line	:	288 HOME ST
Second Line	:
City	:	HUNTINGTON
State	:	IN
Zip	:	46750-1347
Country	:	US
Telephone Number	:	260-200-1407
Fax Number	:	260-200-1408

Provider Business Practice Location Address
First Line	:	288 HOME ST
Second Line	:
City	:	HUNTINGTON
State	:	IN
Zip	:	46750-1347
Country	:	US
Telephone Number	:	260-200-1407
Fax Number	:	260-200-1408

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. SUSAN KAY KING
Credential	:
Telephone Number	:	602-001-4072

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	02/04/2019

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