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General NPI Number Information
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NPI Number | 1699795971
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Entity Type | Organization
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Legal Business Name | FAMILY HOSPICE OF NORTHEAST INDIANA INC
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 11/28/2011
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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 | 260-589-8079
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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 | 260-589-8079
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | SUEANN M. 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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 100053401
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License Number State | IN
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