Healthcare Provider Details

I. General information

NPI: 1053473306
Provider Name (Legal Business Name): UNITED HEALTH SERVICES OF ST. JOSEPH COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 N MAIN ST UNIT 9
GRANGER IN
46530-9681
US

IV. Provider business mailing address

6910 N. MAIN ST. MAIL UNIT 10
GRANGER IN
46530
US

V. Phone/Fax

Practice location:
  • Phone: 574-247-6047
  • Fax: 574-247-6060
Mailing address:
  • Phone: 574-247-6047
  • Fax: 574-247-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: MS. BONITA A. RAINE
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 574-247-6047