MEDICARE: 1ST FAITH HOME CARE SERVICE 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

General Provider Information

NPI Number	:	1972436194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST FAITH HOME CARE SERVICE LLC

Provider Business Mailing Address
First Line	:	2049 HOUSTON ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-4407
Country	:	US
Telephone Number	:	463-271-9218
Fax Number	:	317-982-7189

Provider Business Practice Location Address
First Line	:	2049 HOUSTON ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-4407
Country	:	US
Telephone Number	:	463-271-9218
Fax Number	:	317-982-7189

Authorized Official
Title or Position	:	CEO
Name	:	ANGELA D M HALLIBURTON
Credential	:
Telephone Number	:	463-271-9218

Provider Enumeration Date	:	06/06/2026
Last Update Date	:	06/06/2026

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