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General NPI Number Information
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NPI Number | 1386407906
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Entity Type | Organization
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Legal Business Name | CITADEL HOME CARE INDY LLC
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 7523 COLE WOOD BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46239-7770
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Country | US
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Telephone | 317-488-0495
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Fax |
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Provider Business Mailing Address
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Address Line | 8520 ALLISON POINTE BLVD STE 223
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-4299
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Country | US
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Telephone | 317-488-0495
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANTHONY & TYWANA EASLEY
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Credential |
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Telephone | 317-488-0495
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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 |
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License Number State |
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