Provider Demographics
NPI:1568286706
Name:TANGO CHARLIE ENTERPRISES
Entity type:Organization
Organization Name:TANGO CHARLIE ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:3S,3X, SSGT, USAF
Authorized Official - Phone:317-955-5845
Mailing Address - Street 1:3410 N HIGH SCHOOL RD STE G
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-1100
Mailing Address - Country:US
Mailing Address - Phone:317-526-0943
Mailing Address - Fax:
Practice Address - Street 1:3410 N HIGH SCHOOL RD STE G
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-1100
Practice Address - Country:US
Practice Address - Phone:317-526-0943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)