MEDICARE: HOME HEALTH DEPOT INC

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	332BC3200X	Customized Equipment (DME)	69000381A	IN
2	332B00000X	Durable Medical Equipment & Medical Supplies	69000381A	IN

General Provider Information

NPI Number	:	1083914501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME HEALTH DEPOT INC

Provider Business Mailing Address
First Line	:	9245 N MERIDIAN ST
Second Line	:	SUITE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1836
Country	:	US
Telephone Number	:	317-333-6033
Fax Number	:	317-333-6034

Provider Business Practice Location Address
First Line	:	7781 US 31 S
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-8548
Country	:	US
Telephone Number	:	317-882-9532
Fax Number	:	317-882-9536

Authorized Official
Title or Position	:	DIRECTOR OF CONTRACTING
Name	:	MRS. TERRI GOLDMAN
Credential	:
Telephone Number	:	317-333-6033

Provider Enumeration Date	:	10/31/2010
Last Update Date	:	12/16/2011

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