Provider Demographics
NPI:1417085382
Name:ABSOLUTE CARE OF HAMMOND, INC.
Entity Type:Organization
Organization Name:ABSOLUTE CARE OF HAMMOND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:BERNADETTE
Authorized Official - Last Name:LARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-933-8157
Mailing Address - Street 1:534 CONKEY ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-1146
Mailing Address - Country:US
Mailing Address - Phone:219-933-8157
Mailing Address - Fax:219-933-8273
Practice Address - Street 1:534 CONKEY ST STE 2
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-1146
Practice Address - Country:US
Practice Address - Phone:219-933-8157
Practice Address - Fax:219-933-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200385940AMedicaid
IN200431610AMedicaid