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General NPI Number Information
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NPI Number | 1629367800
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Entity Type | Organization
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Legal Business Name | GRACE HOSPICE OF INDIANA, LLC
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 5838 WEST BRICK RD STE 101
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City | SOUTH BEND
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State | IN
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Zip | 46628-8420
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Country | US
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Telephone | 574-208-9270
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Fax | 855-618-0518
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Provider Business Mailing Address
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Address Line | 500 KIRTS BLVD ATTN: CREDENTIALING DEPARTMENT
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City | TROY
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State | MI
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Zip | 48084-4134
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Country | US
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Telephone | 248-824-6000
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Fax | 855-618-6655
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Authorized Official
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Title or Position | PRESIDENT - HOME HEALTH & HOSPICE
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Name | SCOTT VASEY
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Credential |
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Telephone | 609-781-1535
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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 | 11-012733-1
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License Number State | IN
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