Independence at Home Homecare, LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

INDEPENDENCE AT HOME HOMECARE, LLC

Practice address

2711 Oak Lane Ste 2
Van Buren, AR 72956-8806

Phone

(479) 316-0273

Fax

(479) 208-4098

NPI assigned

Apr 15, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John E Safonov

Title

Owner/President

Phone

(479) 208-3757

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665964800000",
    "number": "1013570274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6292",
            "city": "VAN BUREN",
            "state": "AR",
            "postal_code": "729560241",
            "telephone_number": "479-208-3757",
            "fax_number": "479-208-4098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2711 OAK LANE STE 2",
            "city": "VAN BUREN",
            "state": "AR",
            "postal_code": "729568806",
            "telephone_number": "479-316-0273",
            "fax_number": "479-208-4098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE AT HOME HOMECARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-15",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A",
        "authorized_official_last_name": "SAFONOV",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "479-208-3757"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385HR2065X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Physical Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "232603732",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "indpendenceathome2018@outlook.com",
            "affiliation": "N",
            "endpointDescription": "Business Email Only",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2711 Oak Lane Ste 2",
            "city": "Van Buren",
            "state": "AR",
            "country_code": "US",
            "postal_code": "729568806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eric Daniel Hutsell, PTA
• Gennell Ann Hutsell, OT
• Jacinda Denise Hyatt, PT
• Mohammad Idris, M.D.
• In-Sync Pediatric Therapy
• Kathleen Renee Irwin
• Courtney Leigh Jackson, M.S., CCC-SLP
• Jessica Jackson, MOTR/L
• Chloe Jansson
• JB Wellness PA

• In Home Supportive Care Agency in Van Buren, AR
• Providers in Van Buren, AR by specialty
• In Home Supportive Care Agency in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.