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General NPI Number Information
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NPI Number | 1588976138
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Entity Type | Organization
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Legal Business Name | C & C IN HOME ASSISTANCE
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 07/12/2010
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Provider Practice Location Address
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Address Line | 610 N HIGH SCHOOL RD SUITE B
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City | INDIANAPOLIS
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State | IN
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Zip | 46214-3671
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Country | US
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Telephone | 317-270-9540
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Fax | 317-270-9541
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Provider Business Mailing Address
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Address Line | 610 N HIGH SCHOOL RD SUITE B
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City | INDIANAPOLIS
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State | IN
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Zip | 46214-3671
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Country | US
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Telephone | 317-270-9540
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Fax | 317-270-9541
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. CHARLES DEREK SMILEY
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Credential | CSA
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Telephone | 317-270-9540
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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 | 10-012136-1
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License Number State | IN
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