Healthcare Provider Details

I. General information

NPI: 1013493493
Provider Name (Legal Business Name): GLC HOME HEALTH NIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 PORTER CAMPUS DR STE E&F
VALPARAISO IN
46383-0063
US

IV. Provider business mailing address

3010 LYNDON B JOHNSON FWY STE 1100
DALLAS TX
75234-2712
US

V. Phone/Fax

Practice location:
  • Phone: 219-246-5171
  • Fax: 877-395-0055
Mailing address:
  • Phone: 800-379-1600
  • Fax: 903-537-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number18-005298-1
License Number StateIN

VIII. Authorized Official

Name: KATIE MONASTIERE
Title or Position: COMPLIANCE AND PRIVACY OFFICER
Credential:
Phone: 800-379-1600