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
StateLicense IDTaxonomies
IN08-012029-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health