Provider Demographics
NPI:1962809533
Name:HOMEMAKERS PERSONAL CARE SERVICES, LLC
Entity type:Organization
Organization Name:HOMEMAKERS PERSONAL CARE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-730-3759
Mailing Address - Street 1:6615 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-2043
Mailing Address - Country:US
Mailing Address - Phone:317-730-3759
Mailing Address - Fax:317-220-8283
Practice Address - Street 1:6615 W 79TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-2043
Practice Address - Country:US
Practice Address - Phone:317-730-3759
Practice Address - Fax:317-220-8283
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOMEMAKERS PERSONAL CARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-26
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN140133161251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200514040Medicaid