Provider Demographics
NPI:1871910208
Name:BUSTED WINDMILL LLC
Entity type:Organization
Organization Name:BUSTED WINDMILL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:BRANDT
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-586-2273
Mailing Address - Street 1:2680 E MAIN ST STE 213
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-2828
Mailing Address - Country:US
Mailing Address - Phone:317-586-2273
Mailing Address - Fax:317-837-4901
Practice Address - Street 1:2680 E MAIN ST STE 213
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2828
Practice Address - Country:US
Practice Address - Phone:317-586-2273
Practice Address - Fax:317-837-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13-013031-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care