Healthcare Provider Details

I. General information

NPI: 1639822216
Provider Name (Legal Business Name): WHITE OAK HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 CONNECTICUT DR
CROWN POINT IN
46307-7840
US

IV. Provider business mailing address

9800 CONNECTICUT DR
CROWN POINT IN
46307-7840
US

V. Phone/Fax

Practice location:
  • Phone: 219-237-9563
  • Fax:
Mailing address:
  • Phone: 219-999-5869
  • 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 Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: ROBERTO MORENO
Title or Position: MEMBER OF LLC
Credential:
Phone: 773-576-3100