Healthcare Provider Details

I. General information

NPI: 1891946430
Provider Name (Legal Business Name): MICAH 68 CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 FLICKER CT
INDIANAPOLIS IN
46237-9145
US

IV. Provider business mailing address

8333 FLICKER CT
INDIANAPOLIS IN
46237-9145
US

V. Phone/Fax

Practice location:
  • Phone: 317-888-8560
  • Fax: 317-888-4368
Mailing address:
  • Phone: 317-888-8560
  • Fax: 317-888-4368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number StateIN

VIII. Authorized Official

Name: MRS. JANET EILEEN LINDGREN
Title or Position: PRESIDENT
Credential:
Phone: 317-888-8560