Healthcare Provider Details

I. General information

NPI: 1720955305
Provider Name (Legal Business Name): SUPPORT CONNECT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 COLONY CT
MISHAWAKA IN
46545-3152
US

IV. Provider business mailing address

3325 COLONY CT
MISHAWAKA IN
46545-3152
US

V. Phone/Fax

Practice location:
  • Phone: 623-692-7703
  • Fax:
Mailing address:
  • Phone: 623-692-7703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARIE ANGE INGABIRE
Title or Position: DIRECTOR
Credential:
Phone: 623-692-7703