Provider Demographics
NPI:1407679210
Name:DESIRREE DEDICATED HOME CARE LLC
Entity type:Organization
Organization Name:DESIRREE DEDICATED HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-970-3683
Mailing Address - Street 1:626 CROSSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-8818
Mailing Address - Country:US
Mailing Address - Phone:317-970-3683
Mailing Address - Fax:
Practice Address - Street 1:626 CROSSFIELD DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-8818
Practice Address - Country:US
Practice Address - Phone:317-970-3683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care