Healthcare Provider Details

I. General information

NPI: 1114995610
Provider Name (Legal Business Name): VISION OF MINORITY WOMEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 GUION RD SUITE 308
INDIANAPOLIS IN
46222-1692
US

IV. Provider business mailing address

3520 GUION RD SUITE 308
INDIANAPOLIS IN
46222-1692
US

V. Phone/Fax

Practice location:
  • Phone: 317-920-7144
  • Fax: 317-920-7142
Mailing address:
  • Phone: 317-920-7144
  • Fax: 317-920-7142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number003433
License Number StateIN

VIII. Authorized Official

Name: MRS. LINDA M HENDERSON
Title or Position: ADMINISTRATOR
Credential: R.N.
Phone: 317-920-7144