=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083682728
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTERIM HEALTHCARE OF SE INDIANA, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2006
-----------------------------------------------------
Last Update Date | 08/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3200 N NATIONAL RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47201-3166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-799-1846
-----------------------------------------------------
Fax | 812-799-1848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3200 N NATIONAL RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47201-3166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-799-1846
-----------------------------------------------------
Fax | 812-799-1848
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. THOMAS J DIMARCO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-436-9404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 05-003257-1
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------