Healthcare Provider Details

I. General information

NPI: 1558170837
Provider Name (Legal Business Name): ONE LIFE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 E 30TH ST
INDIANAPOLIS IN
46218-2606
US

IV. Provider business mailing address

1835 E 30TH ST
INDIANAPOLIS IN
46218-2606
US

V. Phone/Fax

Practice location:
  • Phone: 317-721-2474
  • Fax:
Mailing address:
  • Phone: 317-721-2474
  • 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 Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LENA L MIDDLETON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 317-721-2474