MEDICARE: PARKVIEW HOSPITAL, 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

General Provider Information

NPI Number	:	1851927529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKVIEW HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	1450 PRODUCTION RD STE 100
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-1167
Country	:	US
Telephone Number	:	260-373-9775
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 PRODUCTION RD STE 100
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-1167
Country	:	US
Telephone Number	:	260-373-9775
Fax Number	:

Authorized Official
Title or Position	:	SVP/CFO
Name	:	JEANNE WICKENS
Credential	:
Telephone Number	:	260-266-9313

Provider Enumeration Date	:	03/13/2020
Last Update Date	:	03/13/2020

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