Provider Demographics
NPI:1447089487
Name:INDIANA FAMILY CARE GIVERS
Entity type:Organization
Organization Name:INDIANA FAMILY CARE GIVERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-698-2767
Mailing Address - Street 1:11 MUNICIPAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1634
Mailing Address - Country:US
Mailing Address - Phone:317-360-0359
Mailing Address - Fax:
Practice Address - Street 1:11 MUNICIPAL DR STE 200
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1634
Practice Address - Country:US
Practice Address - Phone:317-360-0359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300091358Medicaid