| NPI |
1538757117 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
| Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
| Employer Identification Number EIN |
|
The last name of the provider. If the provider is an individual, this is the legal name. |
| Provider Organization Name Legal Business Name |
IN HOME CARE L.L.C |
The first name of the provider, if the provider
is an individual. |
| Provider Other Organization Name |
INDIANA HOMECARE |
The middle name of the provider, if the provider
is an individual. |
| Provider Other Organization Name Type Code |
3 |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
| Provider First Line Business Practice Location Address |
4955 GERTRUDE DR |
Other last name by which the provider being identified is or has been known. |
| Provider Business Practice Location Address City Name |
MEMPHIS |
Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only. |
| Provider Business Practice Location Address State Name |
TN |
The State code in the location of the provider
being identified. |
| Provider Business Practice Location Address Postal Code |
381255753 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Telephone Number |
9015038845 |
The telephone number associated with the location address of the provider being identified. |
| Provider Enumeration Date |
1/8/2021 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date |
4/26/2022 |
The date that a record was last updated or changed. |
| Authorized Official Last Name |
BURDETTE |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Authorized Official First Name |
PATRICIA |
The first name of the authorized official. |
| Authorized Official Title or Position |
C.E.O |
The title or position of the authorized official. |
| Authorized Official Telephone Number |
9015038845 |
The 10-position telephone number of the authorized official. |
| Healthcare Provider Taxonomy Code 1 |
251E00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
| Is Organization Subpart |
N |
|
| NPI Certification Date |
4/26/2022 |
|