Healthcare Provider Details

I. General information

NPI: 1467393827
Provider Name (Legal Business Name): RESTORATION HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 N MOUNT ST
INDIANAPOLIS IN
46222-3151
US

IV. Provider business mailing address

4120 ANSAR LN
INDIANAPOLIS IN
46254-3123
US

V. Phone/Fax

Practice location:
  • Phone: 463-206-7760
  • Fax:
Mailing address:
  • Phone: 463-206-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICAH BRONER
Title or Position: OWNER
Credential: RN
Phone: 463-206-7760