Healthcare Provider Details

I. General information

NPI: 1063264661
Provider Name (Legal Business Name): CHERISHED AND LOVED COMPANION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5014 E NEW YORK ST
INDIANAPOLIS IN
46201-3714
US

IV. Provider business mailing address

5014 E NEW YORK ST
INDIANAPOLIS IN
46201-3714
US

V. Phone/Fax

Practice location:
  • Phone: 463-237-0244
  • Fax:
Mailing address:
  • Phone: 463-237-0244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMMI HAZEL HINTON
Title or Position: OWNER/AGENCY MANAGER
Credential:
Phone: 463-237-0244