Organization
PREMIUM CAREGIVER SUPPORTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER FORD BSW (OWNER/CEO)
(317) 675-0088
Entity
Organization
Contact information
Practice address
2345 MUNN CIR, INDIANAPOLIS, IN 46229-1479
(317) 675-0088
Mailing address
2345 MUNN CIR, INDIANAPOLIS, IN 46229-1479
(317) 675-0088
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
12/16/2024
Last updated
12/16/2024
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