MEDICARE: ELDER CARE PROVIDERS OF INDIANA, INCORPORATED

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	08-011798-2	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023267127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELDER CARE PROVIDERS OF INDIANA, INCORPORATED

Provider Business Mailing Address
First Line	:	1387 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-3605
Country	:	US
Telephone Number	:	317-357-5411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1387 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-3605
Country	:	US
Telephone Number	:	317-357-5411
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. GEORGETTE SMITH
Credential	:
Telephone Number	:	317-357-5411

Provider Enumeration Date	:	09/12/2008
Last Update Date	:	09/12/2008

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