- Enrollment id
- O20230516000456
- Enrollment state
- NV
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1477228104
- Multiple npi flag
- N
- Ccn
- 297337
- Associate id
- 0648636738
- Organization name
- INDAHOUSE HOMEHEALTH CARE LLC
- Doing business as name
- HOME HEALTH AGENCY
- Incorporation date
- 2021-08-03
- Incorporation state
- NV
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 3305 SPRING MOUNTAIN RD
- Address line 2
- STE 102
- City
- LAS VEGAS
- State
- NV
- Zip code
- 891028629