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General NPI Number Information
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NPI Number | 1124636394
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Entity Type | Organization
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Legal Business Name | ABC COMMUNITY SERVICES LLC
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 1622 ENGLISH AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46201-3912
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Country | US
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Telephone | 317-434-5973
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Fax | 770-872-8267
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Provider Business Mailing Address
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Address Line | 1622 ENGLISH AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46201-3912
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Country | US
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Telephone | 317-434-5973
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Fax | 770-872-8267
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. JACQUELINE EDWARDS
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Credential | MSN, FNPC
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Telephone | 678-237-7183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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