Healthcare Provider Details

I. General information

NPI: 1780687061
Provider Name (Legal Business Name): ST. MARY'S AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 EAGLE CREST BLVD STE B
EVANSVILLE IN
47715-8157
US

IV. Provider business mailing address

10 CADILLAC DR STE 400
BRENTWOOD TN
37027-1001
US

V. Phone/Fax

Practice location:
  • Phone: 812-774-9760
  • Fax: 812-475-1739
Mailing address:
  • Phone: 153-777-0226
  • Fax: 615-373-4457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number007035
License Number StateIN

VIII. Authorized Official

Name: RUSSELL ADKINS
Title or Position: SVP CHIEF LEGAL OFFICER
Credential:
Phone: 615-309-5668