=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033923693
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CIRCLE CITY HOME HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2025
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 W ELM ST STE 170B
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-2392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-564-8305
-----------------------------------------------------
Fax | 317-785-7888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 W ELM ST STE 170B
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-2392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-564-8305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/VICE PRESIDENT
-----------------------------------------------------
Name | AMBER J HUSSAIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-568-0085
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------