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General NPI Number Information
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NPI Number | 1568286706
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Entity Type | Organization
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Legal Business Name | TANGO CHARLIE ENTERPRISES
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 3410 N HIGH SCHOOL RD STE G
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City | INDIANAPOLIS
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State | IN
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Zip | 46224-1100
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Country | US
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Telephone | 317-526-0943
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Fax |
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Provider Business Mailing Address
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Address Line | 3410 N HIGH SCHOOL RD STE G
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City | INDIANAPOLIS
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State | IN
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Zip | 46224-1100
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Country | US
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Telephone | 317-526-0943
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | CHARLES BOOKER
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Credential | 3S,3X, SSGT, USAF
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Telephone | 317-955-5845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #5
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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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