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General NPI Number Information
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NPI Number | 1205228715
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Entity Type | Organization
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Legal Business Name | GILROY HOMECARE, LLC.
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Dates
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Enumeration Date | 02/21/2015
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Last Update Date | 02/21/2015
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Provider Practice Location Address
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Address Line | 6754 DUNSANY LN
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-3667
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Country | US
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Telephone | 317-504-4104
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 533105
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City | INDIANAPOLIS
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State | IN
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Zip | 46253-3105
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | SETH JOHNSON
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Credential |
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Telephone | 317-504-4104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 15-013662-1
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License Number State | IN
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