Provider Demographics
NPI:1124193982
Name:PROMISE HOME SERVICES, INC.
Entity Type:Organization
Organization Name:PROMISE HOME SERVICES, INC.
Other - Org Name:PROMISE CARE AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KINSLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:765-659-4663
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IN
Mailing Address - Zip Code:46041-0415
Mailing Address - Country:US
Mailing Address - Phone:765-659-4663
Mailing Address - Fax:765-659-5355
Practice Address - Street 1:2107 W STATE ROAD 28
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-9184
Practice Address - Country:US
Practice Address - Phone:765-659-4663
Practice Address - Fax:765-659-5355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060049781251E00000X, 251J00000X
IN0700497813747A0650X, 3747P1801X, 374U00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing CareGroup - Single Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200828570OtherIHCP PROVIDER NUMBER