Provider Demographics
NPI:1477588507
Name:PRIORITY REHAB HOME HEALTH LLC
Entity Type:Organization
Organization Name:PRIORITY REHAB HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-688-8232
Mailing Address - Street 1:11576 W US HIGHWAY 30 STE E
Mailing Address - Street 2:
Mailing Address - City:WANATAH
Mailing Address - State:IN
Mailing Address - Zip Code:46390-9300
Mailing Address - Country:US
Mailing Address - Phone:219-733-1001
Mailing Address - Fax:219-733-1002
Practice Address - Street 1:11576 W US HIGHWAY 30 STE E
Practice Address - Street 2:
Practice Address - City:WANATAH
Practice Address - State:IN
Practice Address - Zip Code:46390-9300
Practice Address - Country:US
Practice Address - Phone:219-733-1001
Practice Address - Fax:219-733-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN157562Medicare ID - Type Unspecified