Provider Demographics
NPI:1518962109
Name:PARKVIEW HOSPITAL, INC.
Entity Type:Organization
Organization Name:PARKVIEW HOSPITAL, INC.
Other - Org Name:PARKVIEW HOME HEALTH AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-373-8407
Mailing Address - Street 1:PO BOX 5600
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46895-5600
Mailing Address - Country:US
Mailing Address - Phone:260-373-7008
Mailing Address - Fax:260-373-7059
Practice Address - Street 1:1900 CAREW ST
Practice Address - Street 2:STE 6
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4765
Practice Address - Country:US
Practice Address - Phone:260-373-9800
Practice Address - Fax:260-373-9949
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKVIEW HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-20
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN050083471251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200121480CMedicaid
IN200034360AMedicaid
IN200121480BMedicaid
IN200034360BMedicaid
000000097668OtherANTHEM
IN200034360CMedicaid
IN200121480AMedicaid
IN200034360EMedicaid
IN200121480DMedicaid
700011OtherBLACK LUNG
IN200121480DMedicaid
700011OtherBLACK LUNG