Healthcare Provider Details

I. General information

NPI: 1841079381
Provider Name (Legal Business Name): MRC WRX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 VILLAGE BEND LN
INDIANAPOLIS IN
46254-6248
US

IV. Provider business mailing address

4344 VILLAGE BEND LN
INDIANAPOLIS IN
46254-6248
US

V. Phone/Fax

Practice location:
  • Phone: 317-340-4921
  • Fax:
Mailing address:
  • Phone: 317-340-4921
  • 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: LAURA SHOUSE
Title or Position: CEO
Credential:
Phone: 317-340-4921