Healthcare Provider Details

I. General information

NPI: 1164984597
Provider Name (Legal Business Name): CARE AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 WASHINGTON PARK BLVD
MICHIGAN CITY IN
46360-2056
US

IV. Provider business mailing address

717 WASHINGTON PARK BLVD
MICHIGAN CITY IN
46360-2056
US

V. Phone/Fax

Practice location:
  • Phone: 219-229-1630
  • Fax:
Mailing address:
  • Phone: 219-229-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. RAELONDA M WOODARD
Title or Position: PRESIDENT
Credential: FNP-BC
Phone: 219-229-1630