| NPI | 1053169698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONY JACKS Owner 317-626-0511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 332U00000X Home Delivered Meals |
| 347C00000X Private Vehicle | |
| 385H00000X Respite Care | |
| Enumeration Date | 2024-05-08 |
| Last Update Date | 2024-05-08 |