Provider Demographics
NPI:1003815747
Name:HOOSIER UPLANDS ECONOMIC DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:HOOSIER UPLANDS ECONOMIC DEVELOPMENT CORPORATION
Other - Org Name:HOOSIER UPLANDS HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-849-4447
Mailing Address - Street 1:500 W. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:IN
Mailing Address - Zip Code:47446-1411
Mailing Address - Country:US
Mailing Address - Phone:812-849-4447
Mailing Address - Fax:
Practice Address - Street 1:500 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:IN
Practice Address - Zip Code:47446-1411
Practice Address - Country:US
Practice Address - Phone:812-849-4447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
050094891251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN151556Medicare Oscar/Certification