Healthcare Provider Details

I. General information

NPI: 1730599374
Provider Name (Legal Business Name): SPECIALIZED HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 07/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 N CENTRAL AVE
CONNERSVILLE IN
47331-2012
US

IV. Provider business mailing address

621 N CENTRAL AVE
CONNERSVILLE IN
47331-2012
US

V. Phone/Fax

Practice location:
  • Phone: 317-538-3737
  • Fax:
Mailing address:
  • Phone: 317-538-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number30005122A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number30005122A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number30005122A
License Number StateIN

VIII. Authorized Official

Name: MRS. JACKIE O BODWELL
Title or Position: MEMBER
Credential:
Phone: 317-538-3737