Healthcare Provider Details

I. General information

NPI: 1790652980
Provider Name (Legal Business Name): PEACE AND PROSPERITY HOM HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

9149 STARDUST DR
INDIANAPOLIS IN
46229-1159
US

IV. Provider business mailing address

9149 STARDUST DR
INDIANAPOLIS IN
46229-1159
US

V. Phone/Fax

Practice location:
  • Phone: 317-372-9838
  • Fax:
Mailing address:
  • Phone:
  • 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 Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE LEWIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 317-372-9838