Healthcare Provider Details

I. General information

NPI: 1174341887
Provider Name (Legal Business Name): PROVIDER PARTNERS CARE MANAGEMENT INDIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SAINT JOSEPH DR
KOKOMO IN
46901-1983
US

IV. Provider business mailing address

785 ELKRIDGE LANDING RD STE 300
LINTHICUM HEIGHTS MD
21090-2958
US

V. Phone/Fax

Practice location:
  • Phone: 443-275-9800
  • Fax:
Mailing address:
  • Phone: 410-967-2097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG ALLEN FLEISCHMANN
Title or Position: CFO
Credential:
Phone: 410-241-5063