Healthcare Provider Details

I. General information

NPI: 1619238391
Provider Name (Legal Business Name): GIVING BACK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2356 W INDUSTRIAL PARK DR
BLOOMINGTON IN
47404-2689
US

IV. Provider business mailing address

8455 S SHOREVIEW DR
TRAFALGAR IN
46181-8811
US

V. Phone/Fax

Practice location:
  • Phone: 812-929-0428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number120128131
License Number StateIN

VIII. Authorized Official

Name: MR. KELLY COLLIER
Title or Position: PRESIDENT
Credential:
Phone: 812-929-0428