Provider Demographics
NPI:1386332443
Name:GREAT LENGTHS HOME CARE, LLC
Entity type:Organization
Organization Name:GREAT LENGTHS HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DALONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-689-9101
Mailing Address - Street 1:8888 KEYSTONE XING STE 1300
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-4600
Mailing Address - Country:US
Mailing Address - Phone:317-689-9101
Mailing Address - Fax:
Practice Address - Street 1:8888 KEYSTONE XING STE 1300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-4600
Practice Address - Country:US
Practice Address - Phone:317-689-9101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care