Healthcare Provider Details

I. General information

NPI: 1790059566
Provider Name (Legal Business Name): INTEGRITY HOME CARE PLUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2012
Last Update Date: 02/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5508 E 16TH ST SUITE C13
INDIANAPOLIS IN
46218-4936
US

IV. Provider business mailing address

5508 E 16TH ST SUITE C13
INDIANAPOLIS IN
46218-4936
US

V. Phone/Fax

Practice location:
  • Phone: 317-602-3690
  • Fax: 317-802-7610
Mailing address:
  • Phone: 317-602-3690
  • Fax: 317-802-7610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number10-011901-1
License Number StateIN

VIII. Authorized Official

Name: GLADYS KING
Title or Position: ADMINISTRATOR
Credential: REGISTERED NURSE
Phone: 317-602-3690