Organization
INDIVIDUAL SUPPORT HOME HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIMBERLY JO MOORE (ADMINISTRATOR)
(765) 354-9009
Entity
Organization
Contact information
Practice address
1006 W MILL ST, MIDDLETOWN, IN 47356-9353
(765) 354-9009
(765) 354-9090
Mailing address
1006 W MILL ST, MIDDLETOWN, IN 47356-9353
(765) 354-9009
(765) 354-9090
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
13-01160-1
IN
Other
Enumeration date
01/27/2014
Last updated
01/27/2014
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