Healthcare Provider Details

I. General information

NPI: 1124636394
Provider Name (Legal Business Name): ABC COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 ENGLISH AVE
INDIANAPOLIS IN
46201-3912
US

IV. Provider business mailing address

1622 ENGLISH AVE
INDIANAPOLIS IN
46201-3912
US

V. Phone/Fax

Practice location:
  • Phone: 317-434-5973
  • Fax: 770-872-8267
Mailing address:
  • Phone: 317-434-5973
  • Fax: 770-872-8267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JACQUELINE EDWARDS
Title or Position: DIRECTOR
Credential: MSN, FNPC
Phone: 678-237-7183