Healthcare Provider Details

I. General information

NPI: 1326935149
Provider Name (Legal Business Name): FAMILIAR FACES 2.0
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 55TH PL
INDIANAPOLIS IN
46220-3502
US

IV. Provider business mailing address

2426 55TH PL
INDIANAPOLIS IN
46220-3502
US

V. Phone/Fax

Practice location:
  • Phone: 463-221-2605
  • Fax: 463-221-2507
Mailing address:
  • Phone: 463-221-2605
  • Fax: 463-221-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SASHA M ODOM
Title or Position: CEO
Credential:
Phone: 317-909-1998