Healthcare Provider Details
I. General information
NPI: 1124780465
Provider Name (Legal Business Name): CARELINE HIN100 LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/13/2021
Last Update Date: 03/30/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
600 E CARMEL DR STE 144
CARMEL IN
46032-3053
US
IV. Provider business mailing address
801 ROSEHILL RD
JACKSON MI
49202-1762
US
V. Phone/Fax
- Phone: 517-212-9000
- Fax:
- Phone: 517-212-9000
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RH0002X |
| Taxonomy | Hospice and Palliative Medicine (Internal Medicine) Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 251G00000X |
| Taxonomy | Community Based Hospice Care Agency |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
JOSEPH
DONALD
MEAD
Title or Position: CEO
Credential: JD, MBA
Phone: 517-212-9000