Provider Demographics
NPI:1346426145
Name:DOCTORS HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:DOCTORS HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:574-546-3830
Mailing Address - Street 1:411 S WHITLOCK ST
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:IN
Mailing Address - Zip Code:46506-1626
Mailing Address - Country:US
Mailing Address - Phone:574-546-1995
Mailing Address - Fax:574-546-1981
Practice Address - Street 1:411 S WHITLOCK ST
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:IN
Practice Address - Zip Code:46506-1626
Practice Address - Country:US
Practice Address - Phone:574-546-3830
Practice Address - Fax:574-546-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN08-005356-2OtherSTATE LICENSE
157193Medicare Oscar/Certification