MEDICARE: QWEST PERSONAL CARE INC

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

General Provider Information

NPI Number	:	1285408757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QWEST PERSONAL CARE INC

Provider Business Mailing Address
First Line	:	3500 DEPAUW BLVD # 10819
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-1170
Country	:	US
Telephone Number	:	888-523-9448
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 DEPAUW BLVD # 10819
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-1170
Country	:	US
Telephone Number	:	888-523-9448
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GRANT BROWN
Credential	:
Telephone Number	:	888-523-9448

Provider Enumeration Date	:	11/14/2023
Last Update Date	:	11/14/2023

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