MEDICARE: PUSH HOME CARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	374U00000X	Home Health Aide
2	343900000X	Non-emergency Medical Transport (VAN)
3	376J00000X	Homemaker
4	261QC1500X	Community Health Clinic/Center
5	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1720859929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUSH HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	3917 DENWOOD DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-4428
Country	:	US
Telephone Number	:	765-409-8168
Fax Number	:

Provider Business Practice Location Address
First Line	:	3917 DENWOOD DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-4428
Country	:	US
Telephone Number	:	765-409-8168
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANNON MOODY
Credential	:
Telephone Number	:	765-409-8168

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	09/22/2025

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