Provider Demographics
NPI:1346369568
Name:NORTHERN INDIANA INTERIM HEALTHCARE
Entity Type:Organization
Organization Name:NORTHERN INDIANA INTERIM HEALTHCARE
Other - Org Name:INTERIM HOMESTYLE SERVICES OF FORT WAYNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARCELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:574-233-5186
Mailing Address - Street 1:310 E DUPONT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2048
Mailing Address - Country:US
Mailing Address - Phone:260-969-5991
Mailing Address - Fax:
Practice Address - Street 1:310 E DUPONT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2048
Practice Address - Country:US
Practice Address - Phone:260-969-5991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health