Healthcare Provider Details

I. General information

NPI: 1083276257
Provider Name (Legal Business Name): INDYLIFE HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11679 TYLERS CLOSE
FISHERS IN
46037-4359
US

IV. Provider business mailing address

11679 TYLERS CLOSE
FISHERS IN
46037-4359
US

V. Phone/Fax

Practice location:
  • Phone: 317-457-6656
  • Fax:
Mailing address:
  • Phone: 317-457-6656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KISHORE GAZULA
Title or Position: PRESIDENT / OWNER
Credential:
Phone: 317-457-6656