Provider Demographics
NPI:1417397621
Name:INDIANA SIGNAL HEALTH GROUP NON-SKILLED
Entity Type:Organization
Organization Name:INDIANA SIGNAL HEALTH GROUP NON-SKILLED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-238-1381
Mailing Address - Street 1:PO BOX 15127
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5127
Mailing Address - Country:US
Mailing Address - Phone:765-238-1381
Mailing Address - Fax:303-845-8598
Practice Address - Street 1:1930 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-1218
Practice Address - Country:US
Practice Address - Phone:765-238-1381
Practice Address - Fax:303-845-8598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12-012715-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
INLPI 201052620Medicaid