Healthcare Provider Details

I. General information

NPI: 1548018864
Provider Name (Legal Business Name): SHINING HEARTS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6433 E WASHINGTON ST STE 180
INDIANAPOLIS IN
46219-6682
US

IV. Provider business mailing address

6433 E WASHINGTON ST STE 180
INDIANAPOLIS IN
46219-6682
US

V. Phone/Fax

Practice location:
  • Phone: 317-406-1299
  • Fax:
Mailing address:
  • Phone: 317-406-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: KANEISHA BURRUS
Title or Position: OWNER
Credential:
Phone: 317-406-1299