Healthcare Provider Details

I. General information

NPI: 1588389803
Provider Name (Legal Business Name): AMOR HOMECARE OF INDIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 VILLAGE CT APT 304
JASPER IN
47546-1140
US

IV. Provider business mailing address

11027 106TH ST FL 2
OZONE PARK NY
11417-2614
US

V. Phone/Fax

Practice location:
  • Phone: 917-226-0509
  • Fax:
Mailing address:
  • Phone: 917-226-0509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: AGUSTIN PRADO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 917-226-0509