Provider Demographics
NPI:1114027216
Name:OUR HOSPICE OF SOUTH CENTRAL INDIANA, INC.
Entity Type:Organization
Organization Name:OUR HOSPICE OF SOUTH CENTRAL INDIANA, INC.
Other - Org Name:HOSPICE OF SOUTH CENTRAL INDIANA, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-314-8000
Mailing Address - Street 1:2626 17TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5417
Mailing Address - Country:US
Mailing Address - Phone:812-314-8000
Mailing Address - Fax:812-314-8153
Practice Address - Street 1:2626 17TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5417
Practice Address - Country:US
Practice Address - Phone:812-314-8000
Practice Address - Fax:812-314-8153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2023-05-11
Deactivation Date:2023-04-24
Deactivation Code:
Reactivation Date:2023-05-11
Provider Licenses
StateLicense IDTaxonomies
IN050051191251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200141610Medicaid
IN151502OtherMEDICARE