=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033934401
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RISING ABOVE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2024
-----------------------------------------------------
Last Update Date | 11/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 602 SWEET CREEK DR
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46239-7801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 463-212-9902
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 602 SWEET CREEK DR
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46239-7801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 463-212-9902
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LATOSHA CROWE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 463-212-9902
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------