Healthcare Provider Details

I. General information

NPI: 1831026319
Provider Name (Legal Business Name): ENDLESS SMILES HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10217 LAKE TAHOE CT
FORT WAYNE IN
46804-6916
US

IV. Provider business mailing address

10217 LAKE TAHOE CT
FORT WAYNE IN
46804-6916
US

V. Phone/Fax

Practice location:
  • Phone: 260-515-2956
  • Fax:
Mailing address:
  • Phone: 260-515-2956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: VALERIE BOWEN
Title or Position: OWNER
Credential:
Phone: 260-515-2956