Healthcare Provider Details

I. General information

NPI: 1669475596
Provider Name (Legal Business Name): FAIRMEADOWS HOME HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E MAIN ST
GRIFFITH IN
46319-2932
US

IV. Provider business mailing address

PO BOX 789
SCHERERVILLE IN
46375-0789
US

V. Phone/Fax

Practice location:
  • Phone: 219-865-5960
  • Fax: 219-865-5966
Mailing address:
  • Phone: 219-865-5960
  • Fax: 219-865-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE S KUCKA
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 219-865-5960