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General NPI Number Information
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NPI Number | 1598191553
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Entity Type | Organization
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Legal Business Name | HOME CARE SUPPORT, INC
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Dates
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Enumeration Date | 09/23/2013
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 1635 N IRONWOOD DR STE 1
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City | SOUTH BEND
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State | IN
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Zip | 46635-1847
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Country | US
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Telephone | 574-289-4444
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Fax | 574-247-1564
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Provider Business Mailing Address
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Address Line | 1635 N IRONWOOD DR STE 1
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City | SOUTH BEND
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State | IN
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Zip | 46635-1847
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Country | US
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Telephone | 574-289-4444
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Fax | 574-247-1564
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Authorized Official
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Title or Position | CEO
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Name | MR. JEFF ALISCH SR.
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Credential | BSW, CSA
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Telephone | 574-289-4444
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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 | 12-012237-1
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License Number State | IN
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