Healthcare Provider Details

I. General information

NPI: 1518802743
Provider Name (Legal Business Name): CHAD HUBBARD I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LAQUELA EZELL

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E MARKET ST # 1219
INDIANAPOLIS IN
46204-3250
US

IV. Provider business mailing address

120 E MARKET ST # 1219
INDIANAPOLIS IN
46204-3250
US

V. Phone/Fax

Practice location:
  • Phone: 317-296-1111
  • Fax:
Mailing address:
  • Phone: 317-296-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number250194301
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: