Provider Demographics
NPI:1033114418
Name:DEKALB MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:DEKALB MEMORIAL HOSPITAL INC
Other - Org Name:DEKALB HEALTH HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-925-8699
Mailing Address - Street 1:1316 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-2538
Mailing Address - Country:US
Mailing Address - Phone:260-925-8699
Mailing Address - Fax:260-925-9042
Practice Address - Street 1:400 ERIE PASS
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-0000
Practice Address - Country:US
Practice Address - Phone:260-925-8699
Practice Address - Fax:260-925-9042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEKALB MEMORIAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-14
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN005332251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100264360AMedicaid
IN157157Medicare Oscar/Certification