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General NPI Number Information
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NPI Number | 1972324770
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Entity Type | Organization
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Legal Business Name | INDY HOME ASSIST, LLC
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 1340 GLENEAGLE DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46239-0019
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Country | US
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Telephone | 317-834-7177
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Fax |
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Provider Business Mailing Address
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Address Line | 1340 GLENEAGLE DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46239-0019
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Country | US
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Telephone | 317-834-7177
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LATRICIA GRAVES
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Credential |
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Telephone | 317-834-7177
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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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