MEDICARE: GREAT LAKES CARING HOSPICE C IN, 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	:	1578950895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT LAKES CARING HOSPICE C IN, LLC

Provider Business Mailing Address
First Line	:	3010 LYNDON B JOHNSON FWY STE 1100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-2712
Country	:	US
Telephone Number	:	800-379-1600
Fax Number	:	903-537-8420

Provider Business Practice Location Address
First Line	:	7820 INNOVATION BLVD STE 150A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-2728
Country	:	US
Telephone Number	:	317-537-1140
Fax Number	:	317-837-4130

Authorized Official
Title or Position	:	DIR LICENSE & REGULATORY COMPLIANCE
Name	:	ANGEL STANSBURY
Credential	:
Telephone Number	:	337-344-2141

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	05/14/2026

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