Healthcare Provider Details

I. General information

NPI: 1225864085
Provider Name (Legal Business Name): 1ST MOMENTS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9124 E 25TH ST
INDIANAPOLIS IN
46229-1104
US

IV. Provider business mailing address

9124 E 25TH ST
INDIANAPOLIS IN
46229-1104
US

V. Phone/Fax

Practice location:
  • Phone: 765-609-9023
  • Fax:
Mailing address:
  • Phone: 765-609-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: WHITNEY SCOTT
Title or Position: OWNER
Credential:
Phone: 765-609-9023