Provider Demographics
NPI:1407483225
Name:NDR HOME CARE SERVICE
Entity Type:Organization
Organization Name:NDR HOME CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-750-1203
Mailing Address - Street 1:5209 HOHMAN AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-1719
Mailing Address - Country:US
Mailing Address - Phone:219-750-1203
Mailing Address - Fax:219-512-9031
Practice Address - Street 1:5209 HOHMAN AVE STE 125
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1719
Practice Address - Country:US
Practice Address - Phone:219-750-1203
Practice Address - Fax:219-512-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN190146923OtherLICENSE NUMBER