MEDICARE: MY CARE AT HOME HOME HEALTH CARE SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	16-013957-4	IN

General Provider Information

NPI Number	:	1003344979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY CARE AT HOME HOME HEALTH CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	1516 S HARRISON ST
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-2746
Country	:	US
Telephone Number	:	317-559-4230
Fax Number	:	317-825-0736

Provider Business Practice Location Address
First Line	:	1516 S HARRISON ST
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-2746
Country	:	US
Telephone Number	:	317-559-4230
Fax Number	:	317-825-0736

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	JOANN KAPUNAN WIKSTEN
Credential	:
Telephone Number	:	317-559-4230

Provider Enumeration Date	:	05/23/2017
Last Update Date	:	07/21/2022

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