MEDICARE: LEAGUE FOR THE BLIND AND DISABLED, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	17-014143-2	IN

General Provider Information

NPI Number	:	1013430180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAGUE FOR THE BLIND AND DISABLED, INC

Provider Business Mailing Address
First Line	:	5821 S ANTHONY BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46816-3701
Country	:	US
Telephone Number	:	260-441-0551
Fax Number	:	260-441-7760

Provider Business Practice Location Address
First Line	:	5821 S ANTHONY BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46816-3701
Country	:	US
Telephone Number	:	260-441-0551
Fax Number	:	260-441-7760

Authorized Official
Title or Position	:	DIRECTOR OF NURSING IN HOME HEALTH
Name	:	MELANIE REY
Credential	:	REGISTERED NURSE
Telephone Number	:	260-441-0551

Provider Enumeration Date	:	07/20/2017
Last Update Date	:	07/21/2022

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