Provider Demographics
NPI:1306029244
Name:INDIANA MASONIC HOME, INC.
Entity Type:Organization
Organization Name:INDIANA MASONIC HOME, INC.
Other - Org Name:ACACIA HOME HEALTH & HOSPICES SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIMEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-736-6141
Mailing Address - Street 1:690 STATE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2553
Mailing Address - Country:US
Mailing Address - Phone:317-736-6141
Mailing Address - Fax:317-736-0454
Practice Address - Street 1:690 STATE ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2553
Practice Address - Country:US
Practice Address - Phone:317-736-6141
Practice Address - Fax:317-736-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INPENDING251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
INPENDINGMedicare PIN