Provider Demographics
NPI:1114474707
Name:HRS HOME HEALTH OF INDIANA LLC
Entity Type:Organization
Organization Name:HRS HOME HEALTH OF INDIANA LLC
Other - Org Name:ACCENTCARE HOME HEALTH OF INDIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP LEGAL
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SISCEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-221-0465
Mailing Address - Street 1:11037 BROADWAY STE C
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-0066
Mailing Address - Country:US
Mailing Address - Phone:219-750-9211
Mailing Address - Fax:219-440-4851
Practice Address - Street 1:11037 BROADWAY STE C
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-0066
Practice Address - Country:US
Practice Address - Phone:219-750-9211
Practice Address - Fax:219-440-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INPROVISIONAL LICENSE251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300026939Medicaid