Provider Demographics
NPI:1528724358
Name:HOME HOSPICE OF CENTRAL INDIANA, LLC
Entity type:Organization
Organization Name:HOME HOSPICE OF CENTRAL INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TAMEKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-393-3275
Mailing Address - Street 1:200 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-1678
Mailing Address - Country:US
Mailing Address - Phone:765-393-3275
Mailing Address - Fax:765-393-3218
Practice Address - Street 1:200 E 11TH ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-1678
Practice Address - Country:US
Practice Address - Phone:765-393-3275
Practice Address - Fax:765-393-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based