Healthcare Provider Details

I. General information

NPI: 1356162531
Provider Name (Legal Business Name): BENEFICENT HOME CARE LLC-S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5122 W. REGENT ST
INDIANAPOLIS IN
46241
US

IV. Provider business mailing address

5122 W REGENT ST
INDIANAPOLIS IN
46241-4750
US

V. Phone/Fax

Practice location:
  • Phone: 317-970-4676
  • Fax:
Mailing address:
  • Phone: 317-970-4676
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TOYOSI FAGBEMI
Title or Position: MANAGER
Credential:
Phone: 317-970-4676