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General NPI Number Information
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NPI Number | 1497563100
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Entity Type | Organization
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Legal Business Name | SUPPORTIVE HOME HEALTH LLC
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Dates
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Enumeration Date | 12/27/2024
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 6767 E WASHINGTON ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-6736
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Country | US
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Telephone | 317-400-4049
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Fax | 800-878-7151
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Provider Business Mailing Address
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Address Line | 6767 E WASHINGTON ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-6736
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Country | US
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Telephone | 317-400-4049
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Fax | 800-878-7151
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Authorized Official
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Title or Position | OWNER/VICE PRESIDENT
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Name | SHANA GRAHAM
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Credential |
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Telephone | 317-531-1550
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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 |
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