Healthcare Provider Details

I. General information

NPI: 1336991207
Provider Name (Legal Business Name): INNUCARE SHARED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 NIGHTHAWK WAY
INDIANAPOLIS IN
46254-4770
US

IV. Provider business mailing address

5435 NIGHTHAWK WAY
INDIANAPOLIS IN
46254-4770
US

V. Phone/Fax

Practice location:
  • Phone: 317-796-8682
  • Fax: 317-536-3196
Mailing address:
  • Phone: 317-796-8682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: LATONIA TRIPLETT
Title or Position: CEO
Credential: REGISTERED NURSE
Phone: 317-796-8682