MEDICARE: FAIRMEADOWS HOME HEALTH CENTER, 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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000097364	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669475596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRMEADOWS HOME HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 789
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-0789
Country	:	US
Telephone Number	:	219-865-5960
Fax Number	:	219-865-5966

Provider Business Practice Location Address
First Line	:	1325 E MAIN ST
Second Line	:
City	:	GRIFFITH
State	:	IN
Zip	:	46319-2932
Country	:	US
Telephone Number	:	219-865-5960
Fax Number	:	219-865-5966

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GEORGE S KUCKA
Credential	:	R.PH.
Telephone Number	:	219-865-5960

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/17/2018

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