=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891080545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAREBRIDGE PALLIATIVE CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2011
-----------------------------------------------------
Last Update Date | 08/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5941 FALCON WAY
-----------------------------------------------------
City | GUILFORD
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47022-8753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-218-3454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5941 FALCON WAY
-----------------------------------------------------
City | GUILFORD
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47022-8753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-218-3454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL NURSE SPECIALIST
-----------------------------------------------------
Name | MS. LORI ANN SCHMERR
-----------------------------------------------------
Credential | MS, RN, CNS
-----------------------------------------------------
Telephone | 513-218-3454
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | RN298215
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------