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General NPI Number Information
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NPI Number | 1487250767
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Entity Type | Organization
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Legal Business Name | BLOOMINGTON TRAVELERS LLC
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Dates
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Enumeration Date | 12/10/2020
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 3930 E LARRY WAYNE DR
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City | BLOOMINGTON
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State | IN
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Zip | 47401-9381
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Country | US
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Telephone | 317-874-6122
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Fax |
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Provider Business Mailing Address
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Address Line | 2615 E 3RD ST
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City | BLOOMINGTON
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State | IN
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Zip | 47401-5396
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASSISTANT MANAGER
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Name | RASHMIN B PATEL
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Credential |
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Telephone | 317-874-6122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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