MEDICARE: HOME CARE SUPPORT, INC

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	12-012237-1	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200974790-A	OTHER	IN	MEDICADE LEGACY PROVIDER NUMBER

General Provider Information

NPI Number	:	1598191553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME CARE SUPPORT, INC

Provider Business Mailing Address
First Line	:	1635 N IRONWOOD DR STE 1
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46635-1847
Country	:	US
Telephone Number	:	574-289-4444
Fax Number	:	574-247-1564

Provider Business Practice Location Address
First Line	:	1635 N IRONWOOD DR STE 1
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46635-1847
Country	:	US
Telephone Number	:	574-289-4444
Fax Number	:	574-247-1564

Authorized Official
Title or Position	:	CEO
Name	:	MR. JEFF ALISCH SR.
Credential	:	BSW, CSA
Telephone Number	:	574-289-4444

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	09/23/2013

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