Healthcare Provider Details

I. General information

NPI: 1760955520
Provider Name (Legal Business Name): MOLLER ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12517 RICHLANE DR
INDIANAPOLIS IN
46236-9323
US

IV. Provider business mailing address

12517 RICHLANE DR
INDIANAPOLIS IN
46236-9323
US

V. Phone/Fax

Practice location:
  • Phone: 317-753-5013
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSE DANIEL MITJAVILA
Title or Position: CONSULTANT
Credential:
Phone: 317-385-9121