Healthcare Provider Details

I. General information

NPI: 1750914479
Provider Name (Legal Business Name): INDIANA SIGNAL HEALTH GROUP SKILLED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 CHESTER BLVD
RICHMOND IN
47374-1214
US

IV. Provider business mailing address

PO BOX 15127
LAS VEGAS NV
89114-5127
US

V. Phone/Fax

Practice location:
  • Phone: 765-238-1381
  • Fax: 303-845-8598
Mailing address:
  • Phone: 765-238-1381
  • Fax: 303-845-8598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: HAHN MARCH
Title or Position: PRESIDENT
Credential:
Phone: 765-238-1381