Provider Demographics
NPI:1588389803
Name:AMOR HOMECARE OF INDIANA
Entity type:Organization
Organization Name:AMOR HOMECARE OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AGUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-226-0509
Mailing Address - Street 1:11027 106TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2614
Mailing Address - Country:US
Mailing Address - Phone:917-226-0509
Mailing Address - Fax:
Practice Address - Street 1:501 VILLAGE CT APT 304
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1140
Practice Address - Country:US
Practice Address - Phone:917-226-0509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22-015807-1OtherHOMECARE LICENSE