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General NPI Number Information
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NPI Number | 1689826992
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Entity Type | Organization
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Legal Business Name | FAMILY HOSPICE OF NORTHEAST INDIANA
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Dates
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Enumeration Date | 10/17/2008
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Last Update Date | 10/17/2008
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Provider Practice Location Address
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Address Line | 265 W WATER ST
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City | BERNE
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State | IN
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Zip | 46711-1547
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Country | US
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Telephone | 260-589-8598
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Fax | 260-589-8065
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Provider Business Mailing Address
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Address Line | 265 W WATER ST
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City | BERNE
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State | IN
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Zip | 46711-1547
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Country | US
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Telephone | 260-589-8598
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Fax | 260-589-8065
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Authorized Official
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Title or Position | CEO
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Name | MRS. SUEANN REYNOLDS
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Credential |
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Telephone | 260-589-8598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 01064091A
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License Number State | IN
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