Individual
SUZETT MOFFITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2401 N TIBBS AVE, INDIANAPOLIS, IN 46222-2457
(317) 755-7664
(317) 955-7567
Mailing address
2401 N TIBBS AVE, INDIANAPOLIS, IN 46222-2457
(317) 755-7664
(317) 955-7567
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
14-013067-1
IN
253Z00000X
In Home Supportive Care Agency
Primary
14-013067-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14-013067-1
INDIANA STATE DEPARTMENT OF HEALTH
IN
01
—
201172830A
INDIANA STATE DEPARTMENT OF HEALTH
IN
01
—
76110000
DEPARTMENT OF ADMINISTRATION
IN
01
—
829814297
CCR REGISTRATION
IN
01
—
A0H1301OSSTKEAN
CMS EHR CERTIFICATION ID
IN
Enumeration date
06/02/2014
Last updated
02/20/2020
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