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General NPI Number Information
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NPI Number | 1962398313
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Entity Type | Organization
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Legal Business Name | DEEPLY ROOTED HOME CARE LLC
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 5671 PRESTONWOOD CT
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-5022
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Country | US
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Telephone | 317-603-9497
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Fax |
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Provider Business Mailing Address
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Address Line | 5671 PRESTONWOOD CT
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-5022
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Country | US
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Telephone | 317-487-9185
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ERICA M JACKSON
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Credential |
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Telephone | 317-487-9185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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