Provider Demographics
NPI:1992405518
Name:INFUSION CARE GROUP LLC
Entity type:Organization
Organization Name:INFUSION CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-458-1263
Mailing Address - Street 1:805 SIMON RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46748-9612
Mailing Address - Country:US
Mailing Address - Phone:260-458-1263
Mailing Address - Fax:260-279-2434
Practice Address - Street 1:805 SIMON RD
Practice Address - Street 2:
Practice Address - City:HUNTERTOWN
Practice Address - State:IN
Practice Address - Zip Code:46748-9612
Practice Address - Country:US
Practice Address - Phone:260-458-1263
Practice Address - Fax:260-279-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health