Provider Demographics
NPI:1437278652
Name:NORTHERN INDIANA INTERIM HEALTHCARE
Entity Type:Organization
Organization Name:NORTHERN INDIANA INTERIM HEALTHCARE
Other - Org Name:INTERIM HOMESTYLE SERVICES OF SOUTH BEND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARCELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:574-252-5186
Mailing Address - Street 1:605 W EDISON RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-8823
Mailing Address - Country:US
Mailing Address - Phone:574-252-5186
Mailing Address - Fax:574-232-5245
Practice Address - Street 1:605 W EDISON RD
Practice Address - Street 2:SUITE H
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8823
Practice Address - Country:US
Practice Address - Phone:574-252-5186
Practice Address - Fax:574-232-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health