Healthcare Provider Details

I. General information

NPI: 1578147807
Provider Name (Legal Business Name): CHOSEN HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 S ROGERS ST
BLOOMINGTON IN
47403-4352
US

IV. Provider business mailing address

3230 S ROGERS ST
BLOOMINGTON IN
47403-4352
US

V. Phone/Fax

Practice location:
  • Phone: 812-909-9150
  • Fax:
Mailing address:
  • Phone: 812-909-9150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DIRK BLAND
Title or Position: OWNER
Credential:
Phone: 812-909-9150