Healthcare Provider Details

I. General information

NPI: 1821159641
Provider Name (Legal Business Name): TEAM SELECT HOME CARE OF INDIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 N WASHINGTON ST STE 1
KOKOMO IN
46901-4503
US

IV. Provider business mailing address

2999 N 44TH ST STE 100
PHOENIX AZ
85018-7247
US

V. Phone/Fax

Practice location:
  • Phone: 765-201-4314
  • Fax: 765-205-5044
Mailing address:
  • Phone: 480-618-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number06-005843-1
License Number StateIN

VIII. Authorized Official

Name: MIKE LOVELL
Title or Position: VICE PRESIDENT
Credential:
Phone: 806-185-7604