Provider Demographics
NPI:1114241510
Name:FOSTER HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:FOSTER HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONELL
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:317-816-2273
Mailing Address - Street 1:921 E 86TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1859
Mailing Address - Country:US
Mailing Address - Phone:317-816-2273
Mailing Address - Fax:317-816-2275
Practice Address - Street 1:921 E 86TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1859
Practice Address - Country:US
Practice Address - Phone:317-816-2273
Practice Address - Fax:317-816-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201050820Medicaid
IN201050820Medicaid