Healthcare Provider Details

I. General information

NPI: 1164251419
Provider Name (Legal Business Name): DEWAN HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 W 86TH ST SUITE 240
INDIANAPOLIS IN
46268-1538
US

IV. Provider business mailing address

5455 W 86TH ST SUITE 240
INDIANAPOLIS IN
46268-1538
US

V. Phone/Fax

Practice location:
  • Phone: 317-646-2512
  • Fax:
Mailing address:
  • Phone: 317-646-2512
  • 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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. KARLA LEGG
Title or Position: OPS MANAGER
Credential:
Phone: 317-646-2512