Healthcare Provider Details

I. General information

NPI: 1861092512
Provider Name (Legal Business Name): GIVINGBACK3
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 N MONROE ST
BLOOMINGTON IN
47404-2141
US

IV. Provider business mailing address

1905 N MONROE ST
BLOOMINGTON IN
47404-2141
US

V. Phone/Fax

Practice location:
  • Phone: 812-929-0428
  • Fax:
Mailing address:
  • Phone: 812-929-0428
  • 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: MR. KELLY COLLIER
Title or Position: PRESIDENT
Credential:
Phone: 812-929-0428