MEDICARE: OVER THE MOON HOME HEALTH, 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	:	1427865898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OVER THE MOON HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	2727 E. 56TH STREET SUITE F
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220
Country	:	US
Telephone Number	:	317-698-1959
Fax Number	:	317-458-2535

Provider Business Practice Location Address
First Line	:	2737 E 56TH ST STE D
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-3500
Country	:	US
Telephone Number	:	317-698-1959
Fax Number	:	317-458-2535

Authorized Official
Title or Position	:	OWNER
Name	:	MARY JO MOODY
Credential	:
Telephone Number	:	317-698-1959

Provider Enumeration Date	:	12/18/2024
Last Update Date	:	02/19/2026

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