Provider Demographics
NPI:1083682728
Name:INTERIM HEALTHCARE OF SE INDIANA, INC.
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF SE INDIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-436-9404
Mailing Address - Street 1:3200 N NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-3166
Mailing Address - Country:US
Mailing Address - Phone:812-799-1846
Mailing Address - Fax:812-799-1848
Practice Address - Street 1:3200 N NATIONAL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3166
Practice Address - Country:US
Practice Address - Phone:812-799-1846
Practice Address - Fax:812-799-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-003257-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200468700Medicaid
IN200424030Medicaid
IN000000346938OtherANTHEM
IN200468700Medicaid
IN200424030Medicaid