Provider Demographics
NPI:1285357764
Name:ANGEL HEARTS ADULT DAY CENTER LLC
Entity type:Organization
Organization Name:ANGEL HEARTS ADULT DAY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-721-2677
Mailing Address - Street 1:8520 ALLISON POINTE BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4299
Mailing Address - Country:US
Mailing Address - Phone:317-721-2677
Mailing Address - Fax:888-562-0455
Practice Address - Street 1:8520 ALLISON POINTE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4299
Practice Address - Country:US
Practice Address - Phone:317-721-2677
Practice Address - Fax:888-562-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN014930OtherLICENSE