Healthcare Provider Details

I. General information

NPI: 1003635319
Provider Name (Legal Business Name): RDC HOMECARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 CLUSTER PINE DR
INDIANAPOLIS IN
46235-5820
US

IV. Provider business mailing address

3104 CLUSTER PINE DR
INDIANAPOLIS IN
46235-5820
US

V. Phone/Fax

Practice location:
  • Phone: 773-726-6542
  • Fax:
Mailing address:
  • Phone: 773-726-6542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
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: ROSE MARIE GOODMAN
Title or Position: CEO
Credential:
Phone: 773-726-6542