MEDICARE: EVOLVING LIVES HOMECARE 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

General Provider Information

NPI Number	:	1144029034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVING LIVES HOMECARE LLC

Provider Business Mailing Address
First Line	:	2033 W 63RD ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-4306
Country	:	US
Telephone Number	:	317-319-8599
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 W 63RD ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-4306
Country	:	US
Telephone Number	:	317-319-8599
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DIONNA JANAI MILES
Credential	:
Telephone Number	:	317-317-8599

Provider Enumeration Date	:	03/12/2025
Last Update Date	:	03/12/2025

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