Healthcare Provider Details

I. General information

NPI: 1649088311
Provider Name (Legal Business Name): FRUITOFTHESPIRITLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5437 FALLWOOD DR APT 115
INDIANAPOLIS IN
46220-5657
US

IV. Provider business mailing address

5437 FALLWOOD DR APT 115
INDIANAPOLIS IN
46220-5657
US

V. Phone/Fax

Practice location:
  • Phone: 317-444-9057
  • Fax:
Mailing address:
  • Phone: 317-444-9057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: MISS EBONY DAVIS
Title or Position: OWNER
Credential:
Phone: 317-444-9057