Healthcare Provider Details

I. General information

NPI: 1073127023
Provider Name (Legal Business Name): FED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2020
Last Update Date: 11/01/2020
Certification Date: 11/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 W 94TH CT
CROWN POINT IN
46307-2217
US

IV. Provider business mailing address

1446 W 94TH CT
CROWN POINT IN
46307-2217
US

V. Phone/Fax

Practice location:
  • Phone: 219-779-1280
  • Fax:
Mailing address:
  • Phone: 219-779-1280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL OGAGAWORDIA BIOKORO
Title or Position: MEMBER
Credential:
Phone: 219-779-1280