=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992529630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PASSIONATE PALS PERSONAL CARE AGENCY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2024
-----------------------------------------------------
Last Update Date | 11/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4858 COVERED BRIDGE RD APT D
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46268-3429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-720-8571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4858 COVERED BRIDGE RD APT D
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46268-3429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-720-8571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ZIMMYRA DEAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-720-8571
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------