Healthcare Provider Details

I. General information

NPI: 1033585963
Provider Name (Legal Business Name): INDIANA STATE HOME HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6111 HARRISON ST
MERRILLVILLE IN
46410-2969
US

IV. Provider business mailing address

6111 HARRISON ST
MERRILLVILLE IN
46410-2969
US

V. Phone/Fax

Practice location:
  • Phone: 773-852-7866
  • Fax:
Mailing address:
  • Phone: 773-852-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANSAR MOHAMMED
Title or Position: PRESIDENT
Credential:
Phone: 773-852-7866