Provider Demographics
NPI:1437623832
Name:TALITHA KOUM
Entity Type:Organization
Organization Name:TALITHA KOUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTEWIG
Authorized Official - Suffix:
Authorized Official - Credentials:CAPRC II
Authorized Official - Phone:317-525-7791
Mailing Address - Street 1:527 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-2353
Mailing Address - Country:US
Mailing Address - Phone:317-318-1033
Mailing Address - Fax:
Practice Address - Street 1:527 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-2353
Practice Address - Country:US
Practice Address - Phone:317-318-1033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management