Healthcare Provider Details

I. General information

NPI: 1457115057
Provider Name (Legal Business Name): PRUDENT HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52788 RUTH ST
GRANGER IN
46530-9524
US

IV. Provider business mailing address

52788 RUTH ST
GRANGER IN
46530-9524
US

V. Phone/Fax

Practice location:
  • Phone: 574-229-4258
  • Fax:
Mailing address:
  • Phone: 574-229-4258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: SYLVIA W MACHARIA
Title or Position: ADMNISTRATOR
Credential:
Phone: 574-229-4258