Healthcare Provider Details

I. General information

NPI: 1073448510
Provider Name (Legal Business Name): CHESTNUT HILL INDIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9511 ANGOLA CT STE 207
INDIANAPOLIS IN
46268-3193
US

IV. Provider business mailing address

9511 ANGOLA CT STE 207
INDIANAPOLIS IN
46268-3193
US

V. Phone/Fax

Practice location:
  • Phone: 978-828-8887
  • Fax:
Mailing address:
  • Phone: 978-828-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTON PUKHOVITSKY
Title or Position: DIRECTOR
Credential:
Phone: 978-828-8887