MEDICARE: LA PORTE HOME CARE SERVICES, 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1508224718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA PORTE HOME CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	901 S WOODLAND AVE
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-5672
Country	:	US
Telephone Number	:	219-871-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 S WOODLAND AVE
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-5672
Country	:	US
Telephone Number	:	219-871-8100
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR/AUTHORIZED OFFICIAL
Name	:	MS. LAURIE J HOLTSFORD
Credential	:
Telephone Number	:	615-465-7466

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	02/02/2016

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