Healthcare Provider Details

I. General information

NPI: 1770354029
Provider Name (Legal Business Name): ANGEL HANDS HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6214 MORENCI TRL STE 150
INDIANAPOLIS IN
46268-4871
US

IV. Provider business mailing address

6429 KENTSTONE DR
INDIANAPOLIS IN
46268-4864
US

V. Phone/Fax

Practice location:
  • Phone: 317-450-8395
  • Fax:
Mailing address:
  • Phone: 317-450-8395
  • 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 Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: SUNDAY LARRY OMOTOSO
Title or Position: MANAGER
Credential:
Phone: 317-450-8395