Healthcare Provider Details

I. General information

NPI: 1184957219
Provider Name (Legal Business Name): INTEGRATED HOME HEATH CARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8964 COCKERHAM CIR
INDIANAPOLIS IN
46278-5044
US

IV. Provider business mailing address

8964 COCKERHAM CIR
INDIANAPOLIS IN
46278-5044
US

V. Phone/Fax

Practice location:
  • Phone: 317-412-8531
  • Fax: 317-344-3159
Mailing address:
  • Phone: 317-412-8531
  • Fax: 317-344-3159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateIN

VIII. Authorized Official

Name: MRS. VICTORIA ALEXANDRIA KEATON
Title or Position: PRESIDENT/CEO
Credential: MSN
Phone: 317-412-8531