=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376346312
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRAYS CARE AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2025
-----------------------------------------------------
Last Update Date | 03/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9964 WORTHINGTON BLVD
-----------------------------------------------------
City | FISHERS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46038-3070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-579-5419
-----------------------------------------------------
Fax | 317-579-5419
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9964 WORTHINGTON BLVD
-----------------------------------------------------
City | FISHERS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46038-3070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-579-5419
-----------------------------------------------------
Fax | 317-579-5419
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MECOLE GRAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-579-5419
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------