Provider Demographics
NPI:1184319873
Name:DAVIDA LLC
Entity type:Organization
Organization Name:DAVIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEDARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-590-5893
Mailing Address - Street 1:4914 TUSCANY LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5457
Mailing Address - Country:US
Mailing Address - Phone:317-590-5893
Mailing Address - Fax:463-242-5964
Practice Address - Street 1:4914 TUSCANY LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5457
Practice Address - Country:US
Practice Address - Phone:317-590-5893
Practice Address - Fax:463-242-5964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care