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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 Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851510085
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 :
Fax Number :
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 : 260-469-3079
Authorized Official
Title or Position : CASE MANAGER SUPERVISOR
Name : BETH KRUDOP
Credential :
Telephone Number : 260-745-1200
Provider Enumeration Date : 04/25/2007
Last Update Date : 07/11/2008

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