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General NPI Number Information
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NPI Number | 1306396080
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Entity Type | Organization
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Legal Business Name | AT HEART CARE
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 3549 BOULEVARD PL
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City | INDIANAPOLIS
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State | IN
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Zip | 46208-4403
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Country | US
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Telephone | 317-690-2877
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Fax |
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Provider Business Mailing Address
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Address Line | 1932 MAYFAIR DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-4333
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Country | US
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Telephone | 317-690-2877
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JARRAD RANKIN
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Credential | ATP
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Telephone | 317-690-2877
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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 | 0158236645
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License Number State | IN
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