Healthcare Provider Details

I. General information

NPI: 1780426569
Provider Name (Legal Business Name): SPP ENTERPRISE LLC DBA DYNAMIC HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 SUNNYSIDE RD SUITE 105
INDIANAPOLIS IN
46235
US

IV. Provider business mailing address

5625 N SUNNYSIDE RD SUITE 105
INDIANAPOLIS IN
46235-8513
US

V. Phone/Fax

Practice location:
  • Phone: 463-600-9323
  • Fax:
Mailing address:
  • Phone: 463-600-9323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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 TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MS. DEMETRIA HOLT
Title or Position: CO-OWNER
Credential:
Phone: 463-600-9323