Provider Demographics
NPI:1083751002
Name:VISITING NURSE AND HOSPICE HOME INC
Entity Type:Organization
Organization Name:VISITING NURSE AND HOSPICE HOME INC
Other - Org Name:STILLWATER HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-435-3222
Mailing Address - Street 1:5910 HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-4202
Mailing Address - Country:US
Mailing Address - Phone:260-435-3222
Mailing Address - Fax:260-435-3275
Practice Address - Street 1:5910 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-4202
Practice Address - Country:US
Practice Address - Phone:260-435-3222
Practice Address - Fax:260-435-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100272130AMedicaid
IN100272130AMedicaid