Healthcare Provider Details

I. General information

NPI: 1174562532
Provider Name (Legal Business Name): HAMMOND CARE FROM THE HEART SOCIAL SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 CONKEY ST 2ND FLOOR
HAMMOND IN
46324-1100
US

IV. Provider business mailing address

534 CONKEY ST
HAMMOND IN
46324-1100
US

V. Phone/Fax

Practice location:
  • Phone: 219-933-7111
  • Fax: 219-933-6657
Mailing address:
  • Phone: 219-933-7111
  • Fax: 219-933-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number01194049310012
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number01194049310012
License Number StateIN

VIII. Authorized Official

Name: DEBORAH A. RICHARD
Title or Position: VICE PRESIDENT
Credential:
Phone: 219-933-7111