Provider Demographics
NPI:1114330537
Name:PAGE FAMILY HEARING LLC
Entity Type:Organization
Organization Name:PAGE FAMILY HEARING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KASSANDRA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:POPLAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:219-525-4485
Mailing Address - Street 1:112 E 90TH DR
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410
Mailing Address - Country:US
Mailing Address - Phone:219-525-4485
Mailing Address - Fax:219-472-0633
Practice Address - Street 1:112 E 90TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-525-4485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001344A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN237700000XOtherWPC TAXONOMY CODES
IN193400000XOtherWPC TAXONOMY CODES