MEDICARE: WATCH OVER ME PERSONAL CARE SERVICES 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1568909430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATCH OVER ME PERSONAL CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1915 RED LEAF CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-1997
Country	:	US
Telephone Number	:	317-454-6302
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 RED LEAF CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-1997
Country	:	US
Telephone Number	:	317-454-6302
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LENORE N DEPP
Credential	:
Telephone Number	:	317-454-6302

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	01/30/2017

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