Healthcare Provider Details

I. General information

NPI: 1083359277
Provider Name (Legal Business Name): PRIMECARE HOME CARE SERVICES OF INDIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8945 N MERIDIAN ST STE 110
INDIANAPOLIS IN
46260-5390
US

IV. Provider business mailing address

8063 MADISON AVE # 1035
INDIANAPOLIS IN
46227-6001
US

V. Phone/Fax

Practice location:
  • Phone: 317-559-6062
  • Fax: 317-559-4362
Mailing address:
  • Phone: 317-559-6062
  • Fax: 317-559-4362

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 Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: FARIS FLOURNOY
Title or Position: CEO
Credential:
Phone: 404-904-4276