=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124903000
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELDER'S JOURNEY HOME CARE OF LAFAYETTE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2025
-----------------------------------------------------
Last Update Date | 08/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 EXECUTIVE DRIVE UNIT B-1
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47905-4867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-838-3850
-----------------------------------------------------
Fax | 765-838-8828
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 EXECUTIVE DRIVE UNIT B-1
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47905-4867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-838-3850
-----------------------------------------------------
Fax | 765-838-8828
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | ANN MARIE HARRISON
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 812-360-7041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------