MEDICARE: 360 COMPLETE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1205231883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	360 COMPLETE HOME CARE, LLC

Provider Business Mailing Address
First Line	:	2822 SADDLE BARN WEST DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-1548
Country	:	US
Telephone Number	:	317-488-7797
Fax Number	:

Provider Business Practice Location Address
First Line	:	2822 SADDLE BARN WEST DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-1548
Country	:	US
Telephone Number	:	317-488-7797
Fax Number	:

Authorized Official
Title or Position	:	OWNER OF 360 COMPLETE HOME CARE LLC
Name	:	ERIC MICHAEL GROH
Credential	:
Telephone Number	:	317-488-7797

Provider Enumeration Date	:	10/25/2014
Last Update Date	:	10/25/2014

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