MEDICARE: RETRO HOME HEALTH CARE SERVICES, 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	251E00000X	Home Health Agency	130115571	IN

General Provider Information

NPI Number	:	1316282320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETRO HOME HEALTH CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	1715 N SHADELAND AVE
Second Line	:	SUITE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-2733
Country	:	US
Telephone Number	:	317-869-0981
Fax Number	:	888-449-2412

Provider Business Practice Location Address
First Line	:	1715 N SHADELAND AVE
Second Line	:	SUITE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-2733
Country	:	US
Telephone Number	:	317-869-0981
Fax Number	:	888-449-2412

Authorized Official
Title or Position	:	CEO-OWNER
Name	:	MS. MICHELLE ANDREA CHERRY
Credential	:
Telephone Number	:	317-270-7117

Provider Enumeration Date	:	12/02/2012
Last Update Date	:	12/02/2012

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