Premium Caregiver Supports LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

PREMIUM CAREGIVER SUPPORTS LLC

Practice address

2345 Munn Cir
Indianapolis, IN 46229-1479

Phone

(317) 675-0088

NPI assigned

Dec 16, 2024

Organization subpart

No

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

Authorized official

Name

Mrs. Jennifer Ford, BSW

Title

Owner/Ceo

Phone

(317) 675-0088

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1734307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734307200000",
    "number": "1629885280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 MUNN CIR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462291479",
            "telephone_number": "317-675-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2345 MUNN CIR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462291479",
            "telephone_number": "317-675-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM CAREGIVER SUPPORTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-16",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "317-675-0088",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BSW"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sunita Premkumar, M.D.
• Robin Mical Prendergast, N.P.
• Thomas Prendergast, LCAC

• In Home Supportive Care Agency in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• In Home Supportive Care Agency in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2024; 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.