Provider Demographics
NPI:1063115459
Name:EXECUTIVE HOME CARE LLC
Entity type:Organization
Organization Name:EXECUTIVE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMAH
Authorized Official - Middle Name:W
Authorized Official - Last Name:MUITA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:317-798-7728
Mailing Address - Street 1:2569 BELMONT DR APT 30K
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-5212
Mailing Address - Country:US
Mailing Address - Phone:317-798-7728
Mailing Address - Fax:
Practice Address - Street 1:2569 BELMONT DR APT 30K
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-5212
Practice Address - Country:US
Practice Address - Phone:317-798-7728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child