Provider Demographics
NPI:1124300066
Name:AGGRESSIVE CARE PERSONAL SERVICES LLC
Entity type:Organization
Organization Name:AGGRESSIVE CARE PERSONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-695-5866
Mailing Address - Street 1:6681 W PHILADELPHIA DR
Mailing Address - Street 2:
Mailing Address - City:MC CORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9697
Mailing Address - Country:US
Mailing Address - Phone:317-695-5866
Mailing Address - Fax:317-214-1240
Practice Address - Street 1:6681 W PHILADELPHIA DR
Practice Address - Street 2:
Practice Address - City:MC CORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-9697
Practice Address - Country:US
Practice Address - Phone:317-695-5866
Practice Address - Fax:317-214-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care