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General NPI Number Information
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NPI Number | 1790046795
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Entity Type | Organization
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Legal Business Name | PEAK HOME HEALTH LLC
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 8684 CONNECTICUT ST SUITE A2
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5580
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Country | US
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Telephone | 219-472-9820
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Fax | 219-472-9821
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Provider Business Mailing Address
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Address Line | 8684 CONNECTICUT ST SUITE A2
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5580
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Country | US
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Telephone | 219-472-9820
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Fax | 219-472-9821
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. GWENDOLYN M OGLESBY ODOM
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Credential | RN
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Telephone | 219-472-9820
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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 | 120128881
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License Number State | IN
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