Provider Demographics
NPI:1144220500
Name:CAREAGE OF LOGANSPORT, INC.
Entity Type:Organization
Organization Name:CAREAGE OF LOGANSPORT, INC.
Other - Org Name:CHASE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-722-0307
Mailing Address - Street 1:2 CHASE PARK
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1553
Mailing Address - Country:US
Mailing Address - Phone:574-722-0307
Mailing Address - Fax:574-722-3894
Practice Address - Street 1:2 CHASE PARK
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1553
Practice Address - Country:US
Practice Address - Phone:574-753-4137
Practice Address - Fax:574-722-4139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-000021-1313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100275270AMedicaid
000000259892OtherANTHEM BCBS
100275270OtherAARP
IN100275270Medicaid