Healthcare Provider Details

I. General information

NPI: 1417751645
Provider Name (Legal Business Name): MITCHELL CONTRACTING SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 N PARK AVE
INDIANAPOLIS IN
46205-2740
US

IV. Provider business mailing address

4001 N PARK AVE
INDIANAPOLIS IN
46205-2740
US

V. Phone/Fax

Practice location:
  • Phone: 317-800-1012
  • Fax:
Mailing address:
  • Phone: 317-800-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: BRANDI MITCHELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 317-800-1012