Provider Demographics
NPI:1386536605
Name:LARSEN, EDDIE L
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:L
Last Name:LARSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PACKARD RD
Mailing Address - Street 2:
Mailing Address - City:ARTHUR
Mailing Address - State:NE
Mailing Address - Zip Code:69121-8613
Mailing Address - Country:US
Mailing Address - Phone:317-695-3006
Mailing Address - Fax:
Practice Address - Street 1:90 PACKARD RD
Practice Address - Street 2:
Practice Address - City:ARTHUR
Practice Address - State:NE
Practice Address - Zip Code:69121-8613
Practice Address - Country:US
Practice Address - Phone:317-695-3006
Practice Address - Fax:317-695-3006
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care