Healthcare Provider Details

I. General information

NPI: 1477402626
Provider Name (Legal Business Name): DONESTY'S INDEPENDENT CARE COORDINATION SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12753 BUFF STONE CT
FISHERS IN
46037-4280
US

IV. Provider business mailing address

12753 BUFF STONE CT
FISHERS IN
46037-4280
US

V. Phone/Fax

Practice location:
  • Phone: 317-777-5771
  • Fax: 317-342-4139
Mailing address:
  • Phone: 317-777-5771
  • Fax: 317-342-4139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: STACEY A MCCAULEY
Title or Position: OWNER/CEO
Credential: MSHM
Phone: 317-777-5771