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Organization
HOMEFRONT FAMILY SERVICES
Active
Organization
HOMEFRONT FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY ELLIS (OWNER)
(765) 628-0605
Entity
Organization
Contact information
Practice address
9909 E 100 S, GREENTOWN, IN 46936-9163
(765) 628-0605
(765) 628-3639
Mailing address
9909 E 100 S, GREENTOWN, IN 46936-9163
(765) 628-0605
(765) 628-3639
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
37001000
IN
2251P0200X
Pediatric Physical Therapist
05006820
IN
225XP0200X
Pediatric Occupational Therapist
31002242
IN
235Z00000X
Speech-Language Pathologist
Primary
22004012
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200728940
—
IN
Enumeration date
05/05/2008
Last updated
05/05/2008
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