=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013493493
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLC HOME HEALTH NIN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2018
-----------------------------------------------------
Last Update Date | 01/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 813 PORTER CAMPUS DR STE E&F
-----------------------------------------------------
City | VALPARAISO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46383-0063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-246-5171
-----------------------------------------------------
Fax | 877-395-0055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3010 LYNDON B JOHNSON FWY STE 1100
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-2712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-379-1600
-----------------------------------------------------
Fax | 903-537-8420
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COMPLIANCE AND PRIVACY OFFICER
-----------------------------------------------------
Name | KATIE MONASTIERE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-379-1600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 18-005298-1
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------