Healthcare Provider Details

I. General information

NPI: 1508778721
Provider Name (Legal Business Name): THREE RIVERS HOME CAR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 HESSEN CASSEL RD
FORT WAYNE IN
46806-4579
US

IV. Provider business mailing address

4105 HESSEN CASSEL RD
FORT WAYNE IN
46806-4579
US

V. Phone/Fax

Practice location:
  • Phone: 260-246-8298
  • Fax:
Mailing address:
  • Phone: 260-246-8298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. INNOCENT U ODOH
Title or Position: CEO
Credential: RN
Phone: 260-246-8298