Provider Demographics
NPI:1376538652
Name:ENTRUST HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ENTRUST HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PHEBE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-275-2377
Mailing Address - Street 1:1100 W 42ND ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-3346
Mailing Address - Country:US
Mailing Address - Phone:317-275-2377
Mailing Address - Fax:317-275-2378
Practice Address - Street 1:1100 W 42ND ST
Practice Address - Street 2:SUITE 225
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-3346
Practice Address - Country:US
Practice Address - Phone:317-275-2377
Practice Address - Fax:317-275-2378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003313-1251G00000X
IN080033131251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200393780AMedicaid
IN200393780AMedicaid