MEDICARE: PRIMECARE HOME CARE SERVICES OF INDIANA, 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1083359277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMECARE HOME CARE SERVICES OF INDIANA, LLC

Provider Business Mailing Address
First Line	:	8063 MADISON AVE # 1035
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6001
Country	:	US
Telephone Number	:	317-559-6062
Fax Number	:	317-559-4362

Provider Business Practice Location Address
First Line	:	8945 N MERIDIAN ST STE 110
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5390
Country	:	US
Telephone Number	:	317-559-6062
Fax Number	:	317-559-4362

Authorized Official
Title or Position	:	CEO
Name	:	FARIS FLOURNOY
Credential	:
Telephone Number	:	404-904-4276

Provider Enumeration Date	:	05/02/2022
Last Update Date	:	03/09/2026

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