Healthcare Provider Details

I. General information

NPI: 1588445563
Provider Name (Legal Business Name): 465 HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 E MAIN ST STE 229
PLAINFIELD IN
46168-2830
US

IV. Provider business mailing address

2680 E MAIN ST STE 229
PLAINFIELD IN
46168-2830
US

V. Phone/Fax

Practice location:
  • Phone: 131-721-4811
  • Fax:
Mailing address:
  • Phone: 317-214-8115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JESSICA COULTER
Title or Position: PRESIDENT
Credential:
Phone: 317-214-8115