MEDICARE: PROFESSIONAL NURSING HOME HEALTH CARE 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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1912620220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL NURSING HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	1928 INWOOD DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7111
Country	:	US
Telephone Number	:	260-271-2711
Fax Number	:

Provider Business Practice Location Address
First Line	:	1928 INWOOD DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7111
Country	:	US
Telephone Number	:	260-271-2711
Fax Number	:	260-271-2710

Authorized Official
Title or Position	:	OWNER
Name	:	LUN THANG
Credential	:
Telephone Number	:	260-271-2711

Provider Enumeration Date	:	09/21/2022
Last Update Date	:	01/12/2026

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