Healthcare Provider Details

I. General information

NPI: 1518773977
Provider Name (Legal Business Name): CARDINAL HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5868 E 71ST ST # E609
INDIANAPOLIS IN
46220-4075
US

IV. Provider business mailing address

5868 E 71ST ST # E609
INDIANAPOLIS IN
46220-4075
US

V. Phone/Fax

Practice location:
  • Phone: 317-727-8181
  • Fax: 317-343-9187
Mailing address:
  • Phone:
  • Fax: 317-343-9187

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
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: RAYSHAUNDRA JENKINS
Title or Position: CEO
Credential:
Phone: 317-727-8181