Provider Demographics
NPI: | 1538307913 |
---|---|
Name: | GREATER MICHIANA FAMILY SERVICES, INC. |
Entity Type: | Organization |
Organization Name: | GREATER MICHIANA FAMILY SERVICES, INC. |
Other - Org Name: | GMF SERVICES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT/CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MANGENA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 574-277-4400 |
Mailing Address - Street 1: | 12435 ADAMS RD |
Mailing Address - Street 2: | |
Mailing Address - City: | GRANGER |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46530-6030 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 574-277-4400 |
Mailing Address - Fax: | 574-277-4401 |
Practice Address - Street 1: | 12435 ADAMS RD |
Practice Address - Street 2: | |
Practice Address - City: | GRANGER |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46530-6030 |
Practice Address - Country: | US |
Practice Address - Phone: | 574-277-4400 |
Practice Address - Fax: | 574-277-4401 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-01-23 |
Last Update Date: | 2009-01-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 08-012029-1 | 251E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health |