Healthcare Provider Details

I. General information

NPI: 1770493363
Provider Name (Legal Business Name): PROTECTED PROVISION HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 TREYBURN LAKES WAY
INDIANAPOLIS IN
46239-8895
US

IV. Provider business mailing address

616 TREYBURN LAKES WAY
INDIANAPOLIS IN
46239-8895
US

V. Phone/Fax

Practice location:
  • Phone: 317-658-6516
  • Fax:
Mailing address:
  • Phone: 317-658-6516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMMI LEWIS
Title or Position: PRESIDENT
Credential:
Phone: 317-658-6516