Healthcare Provider Details

I. General information

NPI: 1912811100
Provider Name (Legal Business Name): MJLT HOMECARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6070 GEORGETOWN RD APT D
INDIANAPOLIS IN
46254-1230
US

IV. Provider business mailing address

6070 GEORGETOWN RD APT D
INDIANAPOLIS IN
46254-1230
US

V. Phone/Fax

Practice location:
  • Phone: 267-240-2154
  • Fax:
Mailing address:
  • Phone: 267-240-2154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MAXO MICHEL
Title or Position: OWNER
Credential:
Phone: 267-240-2154