Healthcare Provider Details

I. General information

NPI: 1073377313
Provider Name (Legal Business Name): HISHEALINGHANDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E 21ST AVE OFC 1
GARY IN
46407-2618
US

IV. Provider business mailing address

308 E 21ST AVE OFC 1
GARY IN
46407-2618
US

V. Phone/Fax

Practice location:
  • Phone: 121-980-2428
  • Fax:
Mailing address:
  • Phone: 219-802-4285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: SHONTA SHNORA EDMOND
Title or Position: OWNER/CEO
Credential:
Phone: 219-802-4285