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General NPI Number Information
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NPI Number | 1164984597
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Entity Type | Organization
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Legal Business Name | CARE AT HOME LLC
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Dates
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Enumeration Date | 04/04/2019
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 717 WASHINGTON PARK BLVD
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-2056
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Country | US
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Telephone | 219-229-1630
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Fax |
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Provider Business Mailing Address
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Address Line | 717 WASHINGTON PARK BLVD
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-2056
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Country | US
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Telephone | 219-229-1630
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. RAELONDA M WOODARD
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Credential | FNP-BC
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Telephone | 219-229-1630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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