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NPI Code Detail

MEDICARE: AGING & IN-HOME SERVICES OF NORTHEAST INDIANA, INC.

MEDICARE: AGING & IN-HOME SERVICES OF NORTHEAST INDIANA, 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
1251B00000XCase Management AgencyIN

General Provider Information

NPI Number : 1639209125
Entity Type Code : Organization
Provider Name (Legal Business Name) : AGING & IN-HOME SERVICES OF NORTHEAST INDIANA, INC.
Provider Business Mailing Address
First Line : 2927 LAKE AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-5415
Country : US
Telephone Number : 260-745-1200
Fax Number : 260-456-1066
Provider Business Practice Location Address
First Line : 2927 LAKE AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-5415
Country : US
Telephone Number : 260-745-1200
Fax Number : 260-456-1066
Authorized Official
Title or Position : PRESIDENT
Name : MS. DIANN V MCCORMICK
Credential :
Telephone Number : 260-745-1200
Provider Enumeration Date : 03/06/2007
Last Update Date : 08/22/2020

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