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General NPI Number Information
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NPI Number | 1679336978
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Entity Type | Organization
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Legal Business Name | IDA CARE LLC
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Dates
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Enumeration Date | 01/31/2024
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 6505 E 82ND ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-5538
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Country | US
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Telephone | 463-999-6476
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Fax |
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Provider Business Mailing Address
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Address Line | 5625 N GERMAN CHURCH RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46235-8513
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARKETTA THOMASTON
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Credential |
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Telephone | 317-405-7209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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