Provider Demographics
NPI:1265021695
Name:INDIANAPOLIS JEWISH HOME, INC.
Entity Type:Organization
Organization Name:INDIANAPOLIS JEWISH HOME, INC.
Other - Org Name:AARON-RUBEN-NELSON HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:317-251-2261
Mailing Address - Street 1:7001 HOOVERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260
Mailing Address - Country:US
Mailing Address - Phone:317-251-2261
Mailing Address - Fax:
Practice Address - Street 1:7001 HOOVERWOOD RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-251-2261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1912939315Medicaid