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General NPI Number Information
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NPI Number | 1639209125
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Entity Type | Organization
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Legal Business Name | AGING & IN-HOME SERVICES OF NORTHEAST INDIANA, INC.
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2927 LAKE AVE
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City | FORT WAYNE
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State | IN
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Zip | 46805-5415
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Country | US
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Telephone | 260-745-1200
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Fax | 260-456-1066
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Provider Business Mailing Address
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Address Line | 2927 LAKE AVE
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City | FORT WAYNE
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State | IN
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Zip | 46805-5415
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Country | US
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Telephone | 260-745-1200
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Fax | 260-456-1066
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DIANN V MCCORMICK
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Credential |
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Telephone | 260-745-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | IN
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