Healthcare Provider Details

I. General information

NPI: 1023588043
Provider Name (Legal Business Name): CAREGIVER HOMES OF SOUTH DAKOTA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 CASTLE CREEK PARKWAY NORTH DR STE 425
INDIANAPOLIS IN
46250-4385
US

IV. Provider business mailing address

5975 CASTLE CREEK PARKWAY NORTH DR STE 425
INDIANAPOLIS IN
46250-4385
US

V. Phone/Fax

Practice location:
  • Phone: 617-456-3773
  • Fax: 617-236-7777
Mailing address:
  • Phone: 617-456-3773
  • Fax: 617-236-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: AMY SMITH
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 617-797-0673