MEDICARE: ABLAZE HOME HEALTH SERVICES

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	:	1932679974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABLAZE HOME HEALTH SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 42158
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46242-0158
Country	:	US
Telephone Number	:	317-444-1231
Fax Number	:	317-243-2709

Provider Business Practice Location Address
First Line	:	5610 CRAWFORDSVILLE RD STE 2303
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-3700
Country	:	US
Telephone Number	:	317-444-1231
Fax Number	:	317-243-2709

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LINDA S COSBY
Credential	:
Telephone Number	:	317-444-1231

Provider Enumeration Date	:	12/03/2018
Last Update Date	:	12/03/2018

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