MEDICARE: HOOSIER SENIOR 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	251E00000X	Home Health Agency	10-012443-1	IN
2	253Z00000X	In Home Supportive Care Agency	12-012443-1	IN

General Provider Information

NPI Number	:	1144522798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOOSIER SENIOR CARE LLC

Provider Business Mailing Address
First Line	:	839 MAIN ST
Second Line	:	SUITE 120
City	:	LAFAYETTE
State	:	IN
Zip	:	47901-2830
Country	:	US
Telephone Number	:	800-977-1856
Fax Number	:

Provider Business Practice Location Address
First Line	:	839 MAIN ST
Second Line	:	SUITE 120
City	:	LAFAYETTE
State	:	IN
Zip	:	47901-2830
Country	:	US
Telephone Number	:	800-977-1856
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NATHAN HEDRICK
Credential	:
Telephone Number	:	765-714-7817

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	01/18/2013

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