MEDICARE: VISION OF MINORITY WOMEN, 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	003433	IN

General Provider Information

NPI Number	:	1114995610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION OF MINORITY WOMEN, LLC

Provider Business Mailing Address
First Line	:	3520 GUION RD
Second Line	:	SUITE 308
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-1692
Country	:	US
Telephone Number	:	317-920-7144
Fax Number	:	317-920-7142

Provider Business Practice Location Address
First Line	:	3520 GUION RD
Second Line	:	SUITE 308
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-1692
Country	:	US
Telephone Number	:	317-920-7144
Fax Number	:	317-920-7142

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. LINDA M HENDERSON
Credential	:	R.N.
Telephone Number	:	317-920-7144

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	08/22/2020

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