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General NPI Number Information
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NPI Number | 1639338999
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Entity Type | Organization
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Legal Business Name | MISSION IN HOME SERVICES AND ASSOCIATES LLC
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 4190 S CINDY LN
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City | SALEM
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State | IN
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Zip | 47167-6077
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Country | US
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Telephone | 812-404-6152
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Fax | 812-896-1984
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Provider Business Mailing Address
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Address Line | 4190 S CINDY LN
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City | SALEM
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State | IN
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Zip | 47167-6077
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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 | OWNER MANAGER
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Name | MRS. DIANA MARIE ENGLAND
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Credential |
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Telephone | 812-404-6152
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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 | 200894520
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License Number State | IN
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