Provider Demographics
NPI:1417208588
Name:PASSAGES HOSPICE OF INDIANA, LLC
Entity Type:Organization
Organization Name:PASSAGES HOSPICE OF INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-660-6555
Mailing Address - Street 1:515 WARRENVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2601
Mailing Address - Country:US
Mailing Address - Phone:317-660-6555
Mailing Address - Fax:847-329-9215
Practice Address - Street 1:2325 POINTE PARKWAY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9714
Practice Address - Country:US
Practice Address - Phone:317-660-6555
Practice Address - Fax:847-329-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based