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General NPI Number Information
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NPI Number | 1467507889
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Entity Type | Organization
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Legal Business Name | INDIANA COMMUNITY HOME HEALTHCARE SERVICE L.L.C.
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4532 W PERRY ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46241-6274
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Country | US
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Telephone | 614-376-7447
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Fax |
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Provider Business Mailing Address
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Address Line | 4532 W PERRY ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46241-6274
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Country | US
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Telephone | 614-376-7447
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ABDULKADIR MUKTAR HAJI
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Credential | ABDULKADIR HAJI
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Telephone | 614-376-7447
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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 |
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License Number State | IN
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