Healthcare Provider Details

I. General information

NPI: 1619114576
Provider Name (Legal Business Name): LYTTONCARR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 N MAIN ST STE B
EVANSVILLE IN
47711-5417
US

IV. Provider business mailing address

423 N MAIN ST STE B
EVANSVILLE IN
47711-5417
US

V. Phone/Fax

Practice location:
  • Phone: 812-423-0999
  • Fax: 812-423-2282
Mailing address:
  • Phone: 812-423-0999
  • Fax: 812-423-2282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number08-011990-1
License Number StateIN

VIII. Authorized Official

Name: MR. RALPH ALAN CARR
Title or Position: PRES/AGENCY MGR
Credential:
Phone: 812-423-0999