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General NPI Number Information
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NPI Number | 1619441318
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Entity Type | Organization
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Legal Business Name | HOME CARE ON DEMAND LLC
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Dates
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Enumeration Date | 01/15/2019
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 9465 COUNSELORS ROW STE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-3817
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Country | US
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Telephone | 317-805-4703
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Fax | 317-805-4708
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Provider Business Mailing Address
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Address Line | 9465 COUNSELORS ROW STE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-3817
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Country | US
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Telephone | 317-805-4703
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Fax | 317-805-4708
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Authorized Official
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Title or Position | MANAGER/ADMINISTRATOR
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Name | MS. JACQUELINE SHARESE WYNNE
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Credential | CNA
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Telephone | 317-741-3721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore 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 | 372600000X
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Taxonomy Name | Adult Companion
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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 | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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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 | 376J00000X
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Taxonomy Name | Homemaker
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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