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General NPI Number Information
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NPI Number | 1578950895
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Entity Type | Organization
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Legal Business Name | GREAT LAKES CARING HOSPICE C IN, LLC
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 5420 W SOUTHERN AVE STE 302A
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City | INDIANAPOLIS
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State | IN
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Zip | 46241-5568
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Country | US
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Telephone | 317-537-1140
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Fax | 317-837-4130
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Provider Business Mailing Address
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Address Line | 3010 LYNDON B JOHNSON FWY STE 1100
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City | DALLAS
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State | TX
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Zip | 75234-2712
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Country | US
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Telephone | 800-379-1600
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Fax | 903-537-8420
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Authorized Official
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Title or Position | COMPLIANCE AND PRIVACY OFFICER
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Name | KATIE MONASTIERE
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Credential |
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Telephone | 800-379-1600
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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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