Healthcare Provider Details

I. General information

NPI: 1306846860
Provider Name (Legal Business Name): NORTHERN INDIANA INTERIM HEALTHCARE COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E LUDWIG RD STE 105
FORT WAYNE IN
46825-4240
US

IV. Provider business mailing address

111 E LUDWIG RD STE 105
FORT WAYNE IN
46825-4240
US

V. Phone/Fax

Practice location:
  • Phone: 260-482-9405
  • Fax: 260-482-7180
Mailing address:
  • Phone: 260-482-9405
  • Fax: 260-482-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number04-003294-1
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: STEVEN JAMES ALESSANDRO
Title or Position: CEO
Credential:
Phone: 847-457-1808