Healthcare Provider Details

I. General information

NPI: 1891418018
Provider Name (Legal Business Name): HOME CONNECTION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 N MERIDIAN ST STE B-102
INDIANAPOLIS IN
46208-5820
US

IV. Provider business mailing address

2425 N MERIDIAN ST STE B-102
INDIANAPOLIS IN
46208-5820
US

V. Phone/Fax

Practice location:
  • Phone: 317-986-6205
  • Fax:
Mailing address:
  • Phone: 317-986-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: KELVIN MATEMACHANI
Title or Position: MEMBER
Credential:
Phone: 317-986-6205