Healthcare Provider Details

I. General information

NPI: 1548083512
Provider Name (Legal Business Name): THE CAREGROUP HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12511 LOOKING GLASS WAY
INDIANAPOLIS IN
46235-0006
US

IV. Provider business mailing address

12511 LOOKING GLASS WAY
INDIANAPOLIS IN
46235-0006
US

V. Phone/Fax

Practice location:
  • Phone: 317-922-9475
  • Fax:
Mailing address:
  • Phone: 317-999-9999
  • 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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MICHCHALONDA THOMPSON
Title or Position: CEO
Credential:
Phone: 317-999-9999