Healthcare Provider Details

I. General information

NPI: 1720859929
Provider Name (Legal Business Name): PUSH HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 DENWOOD DR
INDIANAPOLIS IN
46226-4428
US

IV. Provider business mailing address

3917 DENWOOD DR
INDIANAPOLIS IN
46226-4428
US

V. Phone/Fax

Practice location:
  • Phone: 765-409-8168
  • Fax:
Mailing address:
  • Phone: 765-409-8168
  • 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 Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: SHANNON MOODY
Title or Position: OWNER
Credential:
Phone: 765-409-8168