Provider Demographics
NPI:1588435028
Name:HEALTHYCARE HOMECARE LLC
Entity type:Organization
Organization Name:HEALTHYCARE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWNISE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:SLPD
Authorized Official - Phone:219-237-9560
Mailing Address - Street 1:1746 REDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-5165
Mailing Address - Country:US
Mailing Address - Phone:219-237-9560
Mailing Address - Fax:
Practice Address - Street 1:7951 CALUMET AVE
Practice Address - Street 2:#1137
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-237-9560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCEMENT TX LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1427284884OtherNPI
IL1134336894OtherNPI