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General NPI Number Information
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NPI Number | 1508500794
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Entity Type | Organization
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Legal Business Name | CANARY HOME HEALTH CARE OF INDIANA INC
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Dates
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Enumeration Date | 04/24/2022
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Last Update Date | 04/24/2022
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Provider Practice Location Address
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Address Line | 9111 BROADWAY STE I
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City | MERRILLVILLE
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State | IN
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Zip | 46410-8122
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Country | US
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Telephone | 219-333-8498
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Fax |
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Provider Business Mailing Address
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Address Line | 9111 BROADWAY STE II
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7002
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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 | ADMINISTRATOR
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Name | MR. BRANIFF LASTER
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Credential |
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Telephone | 219-333-8498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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