Healthcare Provider Details

I. General information

NPI: 1982477998
Provider Name (Legal Business Name): EMINENCE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 07/25/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9511 ANGOLA CT STE 200
INDIANAPOLIS IN
46268-3190
US

IV. Provider business mailing address

8245 E 96TH ST # 1132
INDIANAPOLIS IN
46256-1013
US

V. Phone/Fax

Practice location:
  • Phone: 317-701-4191
  • Fax:
Mailing address:
  • Phone: 317-701-4191
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: TERRY DOVE
Title or Position: ADMINISTRATOR
Credential:
Phone: 317-701-4191