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General NPI Number Information
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NPI Number | 1780354654
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Entity Type | Organization
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Legal Business Name | ALTRA HOMECARE GROUP, LLC
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 7400 N SHADELAND AVE STE 258
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2886
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Country | US
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Telephone | 317-672-6155
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Fax |
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Provider Business Mailing Address
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Address Line | 7400 N SHADELAND AVE STE 258
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2886
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Country | US
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Telephone | 317-672-6155
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NICHOLAS WYNNE
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Credential |
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Telephone | 317-672-6155
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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 |
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License Number State |
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