Healthcare Provider Details

I. General information

NPI: 1912761552
Provider Name (Legal Business Name): HOME SAFETY & MOBILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 N GERMAN CHURCH RD
INDIANAPOLIS IN
46235-8513
US

IV. Provider business mailing address

5625 N GERMAN CHURCH RD
INDIANAPOLIS IN
46235-8513
US

V. Phone/Fax

Practice location:
  • Phone: 317-389-6966
  • Fax:
Mailing address:
  • Phone: 317-389-6966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID RUNFOLA
Title or Position: PRESIDENT
Credential:
Phone: 317-389-6966