Healthcare Provider Details

I. General information

NPI: 1568444149
Provider Name (Legal Business Name): F C OF INDIANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 E US HIGHWAY 36 STE 1102
AVON IN
46123-8224
US

IV. Provider business mailing address

14841 DALLAS PKWY STE 625
DALLAS TX
75254-7641
US

V. Phone/Fax

Practice location:
  • Phone: 317-334-0859
  • Fax: 317-334-1205
Mailing address:
  • Phone: 214-542-4952
  • Fax: 214-445-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number53741
License Number StateIN

VIII. Authorized Official

Name: ROBERT PARKER
Title or Position: CCO
Credential:
Phone: 214-445-3773