Healthcare Provider Details

I. General information

NPI: 1174221774
Provider Name (Legal Business Name): NURSE WITH US HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 SYMPHONY PL
INDIANAPOLIS IN
46231-4241
US

IV. Provider business mailing address

1535 SYMPHONY PL
INDIANAPOLIS IN
46231-4241
US

V. Phone/Fax

Practice location:
  • Phone: 317-531-8156
  • Fax:
Mailing address:
  • Phone: 317-531-8156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JASMINE ECHOLS
Title or Position: MANAGER
Credential: RN
Phone: 317-531-8156