Healthcare Provider Details

I. General information

NPI: 1356777254
Provider Name (Legal Business Name): ACCESICARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 HIGHLANDER POINT DR
FLOYDS KNOBS IN
47119-9682
US

IV. Provider business mailing address

7780 COOKS MILL RD
GEORGETOWN IN
47122-9524
US

V. Phone/Fax

Practice location:
  • Phone: 812-725-3708
  • Fax:
Mailing address:
  • Phone: 812-725-3708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number13-012880-1
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier201081780A
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer

VIII. Authorized Official

Name: MRS. DEBRA JEAN BAKER
Title or Position: OWNER/MANAGER
Credential: RN
Phone: 812-725-3843