Healthcare Provider Details

I. General information

NPI: 1124193982
Provider Name (Legal Business Name): PROMISE HOME SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 W STATE ROAD 28
FRANKFORT IN
46041-9184
US

IV. Provider business mailing address

PO BOX 415
FRANKFORT IN
46041-0415
US

V. Phone/Fax

Practice location:
  • Phone: 765-659-4663
  • Fax: 765-659-5355
Mailing address:
  • Phone: 765-659-4663
  • Fax: 765-659-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number060049781
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number060049781
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number070049781
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number070049781
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number070049781
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number070049781
License Number StateIN

VIII. Authorized Official

Name: TAMMY LYNN KINSLER
Title or Position: PRESIDENT
Credential: RN
Phone: 765-659-4663