MEDICARE: BEST LIFE HOME CARE, 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	253Z00000X	In Home Supportive Care Agency	11-012571-1	IN

General Provider Information

NPI Number	:	1083994552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEST LIFE HOME CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 781556
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-8556
Country	:	US
Telephone Number	:	317-771-2371
Fax Number	:	877-782-2511

Provider Business Practice Location Address
First Line	:	6439 WATERCREST WAY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-1985
Country	:	US
Telephone Number	:	317-771-2371
Fax Number	:	877-782-2511

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. TARA RAY
Credential	:	MOT, OTR/L
Telephone Number	:	317-771-2371

Provider Enumeration Date	:	08/27/2011
Last Update Date	:	08/27/2011

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