Healthcare Provider Details

I. General information

NPI: 1447337530
Provider Name (Legal Business Name): HCMH DIVERSIFIED MANAGEMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WEST MAIN ST
HAGERSTOWN IN
47346-1214
US

IV. Provider business mailing address

25 WEST MAIN ST
HAGERSTOWN IN
47346-1214
US

V. Phone/Fax

Practice location:
  • Phone: 765-521-1366
  • Fax: 765-521-1555
Mailing address:
  • Phone: 765-521-1366
  • Fax: 765-521-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number60005309A
License Number StateIN

VIII. Authorized Official

Name: MR. PAUL F JANSSEN
Title or Position: PRESIDENT
Credential:
Phone: 765-521-1508