MEDICARE: TERRE HAUTE SENIOR CARE, LLC

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	253Z00000X	In Home Supportive Care Agency	16-013854-1	IN

General Provider Information

NPI Number	:	1063969384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRE HAUTE SENIOR CARE, LLC

Provider Business Mailing Address
First Line	:	631 E SPRINGHILL DR
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47802-4448
Country	:	US
Telephone Number	:	812-645-9266
Fax Number	:	812-645-0644

Provider Business Practice Location Address
First Line	:	631 E SPRINGHILL DR
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47802-4448
Country	:	US
Telephone Number	:	812-645-9266
Fax Number	:	812-645-0644

Authorized Official
Title or Position	:	VICE PRESIDENT OF BUSINESS DEVELOPM
Name	:	MR. DENNIS ALAN GUNTHER
Credential	:
Telephone Number	:	812-471-0050

Provider Enumeration Date	:	09/02/2016
Last Update Date	:	09/02/2016

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