Healthcare Provider Details

I. General information

NPI: 1225228281
Provider Name (Legal Business Name): ABSOLUTE CARE OF HAMMOND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 CONKEY ST 2
HAMMOND IN
46324-1100
US

IV. Provider business mailing address

534 CONKEY ST 2
HAMMOND IN
46324-1100
US

V. Phone/Fax

Practice location:
  • Phone: 219-933-8157
  • Fax: 219-933-8273
Mailing address:
  • Phone: 219-933-8157
  • Fax: 219-933-8273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MS. PHYLLIS BERNADETTE LARK
Title or Position: OWNER
Credential:
Phone: 219-933-8157