Provider Demographics
NPI:1588401897
Name:SHIRLEY'S ANGELS HOME CARE, LLC
Entity type:Organization
Organization Name:SHIRLEY'S ANGELS HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHONTE'
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-644-2249
Mailing Address - Street 1:3901 W 86TH ST STE 360-304
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-5734
Mailing Address - Country:US
Mailing Address - Phone:317-644-2249
Mailing Address - Fax:
Practice Address - Street 1:3901 W 86TH ST STE 360-304
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-5734
Practice Address - Country:US
Practice Address - Phone:317-644-2249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-12
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300093641Medicaid