Provider Demographics
NPI:1982241865
Name:HEART IN HOME OF INDIANA, LLC
Entity type:Organization
Organization Name:HEART IN HOME OF INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-881-9700
Mailing Address - Street 1:494 S EMERSON AVE STE I2
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1914
Mailing Address - Country:US
Mailing Address - Phone:317-881-9700
Mailing Address - Fax:
Practice Address - Street 1:494 S EMERSON AVE STE I2
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1914
Practice Address - Country:US
Practice Address - Phone:317-881-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
INNAMedicaid