Active NPI
Life's Journey of Avon,LLC
Doing business as Life's Journey Hospice
- Community Based Hospice Care Agency
- Plainfield, IN
National Provider Identifier
1629504303
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- LIFE'S JOURNEY OF AVON,LLC
- Doing business as
- Life's Journey Hospice
- Practice address
- 1620 Hawthorne Dr Ste 600
Plainfield, IN 46168-2815 - Phone
- (317) 561-6840
- Fax
- (317) 561-6827
- NPI assigned
- May 2, 2017
- Last updated
- Jun 19, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert D Wallace
- Title
- Ceo
- Phone
- (317) 561-6840
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospice Registered Nurse | 163WH1000X | |||
| Community Based Hospice Care Agency | 251G00000X | Primary | ||
| Inpatient Hospice | 315D00000X |
Addresses
Primary practice location
1620 Hawthorne Dr Ste 600
Plainfield, IN 46168-2815
Mailing address
1620 Hawthorne Dr Ste 600
Plainfield, IN 46168-2815
Phone (317) 561-6840
Other practice location 1
10241 E County Road 100 N
Indianapolis, IN 46234-9016
Phone (317) 561-6840
Other names 1
- Life's Journey Hospice
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181121002356 | IN | Part A Provider - Hospice | 8820342207 | Practice locations: Indianapolis, IN |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1629504303. Details of each certification follow.
Hospice certification: CCN 151628
- Legal name
- LIFE'S JOURNEY OF AVON,LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Oct 15, 2018
- Last certification
- Oct 15, 2018
- Ownership / control type
- Proprietary - Other
- Organization structure
- LLC
- Incorporated
- Jul 19, 2016 in IN
- Enrollment address
- 10241 E County Road 100 N
Indianapolis, IN 46234-9016
Care Compare: Hospice
Medicare Care Compare- Listed as
- Life's Journey of Avon LLC
- Ownership
- For-Profit
- Certified
- Oct 15, 2018
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryLocations
1620 Hawthorne Dr
Ste 600
Plainfield, IN 46168
Phone (317) 561-6840
Ownership & related parties
All disclosed owners & managing parties 4
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Bobm, LLC | 5% Or Greater Direct Ownership Interest | Jul 19, 2016 | 50% |
| Laury M Wallace | Corporate Director | Jul 19, 2016 | 50% |
| Robert Meister | 5% Or Greater Indirect Ownership Interest | Jul 19, 2016 | 50% |
| Robert Wallace | 5% Or Greater Indirect Ownership Interest | Jul 19, 2016 | 50% |
| Corporate Director | Jul 19, 2016 | 50% | |
| W-2 Managing Employee | Jul 19, 2016 | 100% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
Affiliated clinicians 4
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493683200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1718755200000",
"number": "1629504303",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1620 HAWTHORNE DR STE 600",
"city": "PLAINFIELD",
"state": "IN",
"postal_code": "461682815",
"telephone_number": "317-561-6840",
"fax_number": "317-561-6827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1620 HAWTHORNE DR STE 600",
"city": "PLAINFIELD",
"state": "IN",
"postal_code": "461682815",
"telephone_number": "317-561-6840",
"fax_number": "317-561-6827"
}
],
"practiceLocations": [
{
"address_1": "10241 E County Road 100 N",
"address_purpose": "LOCATION",
"city": "Indianapolis",
"state": "IN",
"postal_code": "462349016",
"country_code": "US",
"telephone_number": "317-561-6840",
"fax_number": "317-561-6827",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "LIFE'S JOURNEY OF AVON,LLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-05-02",
"last_updated": "2024-06-19",
"certification_date": "2024-06-19",
"status": "A",
"authorized_official_last_name": "WALLACE",
"authorized_official_first_name": "ROBERT",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "317-561-6840"
},
"taxonomies": [
{
"code": "163WH1000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Registered Nurse, Hospice",
"state": null,
"license": null,
"primary": false
},
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
},
{
"code": "315D00000X",
"taxonomy_group": "",
"desc": "Hospice, Inpatient",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Life's Journey Hospice",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Plainfield, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.