Provider Demographics
NPI:1447255856
Name:INDIANA HOMECARE NETWORK LLC
Entity type:Organization
Organization Name:INDIANA HOMECARE NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-928-2727
Mailing Address - Street 1:1932 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013-2832
Mailing Address - Country:US
Mailing Address - Phone:765-640-4500
Mailing Address - Fax:765-640-9400
Practice Address - Street 1:1932 E 53RD ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-2832
Practice Address - Country:US
Practice Address - Phone:765-640-4500
Practice Address - Fax:765-640-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN003788251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200454290AMedicaid
IN200454290AMedicaid