MEDICARE: HOMEMAKERS 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	251E00000X	Home Health Agency	140133161	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962809533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMEMAKERS PERSONAL CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	6615 W 79TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-2043
Country	:	US
Telephone Number	:	317-730-3759
Fax Number	:	317-220-8283

Provider Business Practice Location Address
First Line	:	6615 W 79TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-2043
Country	:	US
Telephone Number	:	317-730-3759
Fax Number	:	317-220-8283

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MRS. JOYCE ANN RANDOLPH
Credential	:
Telephone Number	:	317-730-3759

Provider Enumeration Date	:	11/26/2014
Last Update Date	:	12/28/2015

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