MEDICARE: ST. JOSEPH HEALTH SYSTEM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		IN

General Provider Information

NPI Number	:	1104870583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOSEPH HEALTH SYSTEM LLC

Provider Business Mailing Address
First Line	:	PO BOX 11229
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46856-1229
Country	:	US
Telephone Number	:	260-425-3000
Fax Number	:	260-425-3222

Provider Business Practice Location Address
First Line	:	700 BROADWAY
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-1402
Country	:	US
Telephone Number	:	260-425-3000
Fax Number	:	260-425-3222

Authorized Official
Title or Position	:	DIRECTOR, BUSINESS OFFICE SERVICES
Name	:	LAURIE HOLTSFORD
Credential	:
Telephone Number	:	615-465-7466

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	11/06/2007

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