Healthcare Provider Details

I. General information

NPI: 1437978640
Provider Name (Legal Business Name): ASPEN PRAIRIE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10974 WINTERCOVE WAY
FISHERS IN
46038-2688
US

IV. Provider business mailing address

11722 ALLISONVILLE RD STE 103-124
FISHERS IN
46038-2324
US

V. Phone/Fax

Practice location:
  • Phone: 317-572-5505
  • Fax:
Mailing address:
  • Phone:
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY HEER
Title or Position: OWNER
Credential:
Phone: 317-777-1207