Healthcare Provider Details

I. General information

NPI: 1124562806
Provider Name (Legal Business Name): HOME HEALTHCARE HEROES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 MAIN ST SUITE E1
ANDERSON IN
46013-4264
US

IV. Provider business mailing address

3310 MAIN ST SUITE E1
ANDERSON IN
46013-4264
US

V. Phone/Fax

Practice location:
  • Phone: 765-298-8234
  • Fax: 765-400-5327
Mailing address:
  • Phone: 765-298-8234
  • Fax: 765-400-5327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number160139971
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DEBORAH K KAKASULEFF
Title or Position: OFFICE MANAGER
Credential:
Phone: 765-298-8234