Healthcare Provider Details

I. General information

NPI: 1114700572
Provider Name (Legal Business Name): LOVE AND GRACE HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 DEPAUW BLVD
INDIANAPOLIS IN
46268-1170
US

IV. Provider business mailing address

8342 QUETICO DR
INDIANAPOLIS IN
46268-1986
US

V. Phone/Fax

Practice location:
  • Phone: 463-249-7130
  • Fax: 317-854-9077
Mailing address:
  • Phone: 463-249-7130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: KAYLYN COOKE
Title or Position: OWNER/ADMINISTRATOR
Credential: NP
Phone: 463-249-7130