Provider Demographics
NPI:1053492025
Name:FRANCISCAN ST. ELIZABETH HEALTH
Entity Type:Organization
Organization Name:FRANCISCAN ST. ELIZABETH HEALTH
Other - Org Name:ST ELIZABETH HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-502-4000
Mailing Address - Street 1:1415 SALEM ST
Mailing Address - Street 2:SUITE 202W
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-4100
Mailing Address - Country:US
Mailing Address - Phone:765-423-6224
Mailing Address - Fax:
Practice Address - Street 1:1415 SALEM ST
Practice Address - Street 2:SUITE 202W
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-4100
Practice Address - Country:US
Practice Address - Phone:765-423-6224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060050031251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200141620Medicaid
IN151563Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER