Provider Demographics
NPI:1225228281
Name:ABSOLUTE CARE OF HAMMOND, INC.
Entity Type:Organization
Organization Name:ABSOLUTE CARE OF HAMMOND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:BERNADETTE
Authorized Official - Last Name:LARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-933-8157
Mailing Address - Street 1:534 CONKEY ST
Mailing Address - Street 2:2
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-1100
Mailing Address - Country:US
Mailing Address - Phone:219-933-8157
Mailing Address - Fax:219-933-8273
Practice Address - Street 1:534 CONKEY ST
Practice Address - Street 2:2
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-1100
Practice Address - Country:US
Practice Address - Phone:219-933-8157
Practice Address - Fax:219-933-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200861760Medicaid
IN200861750AMedicaid