Provider Demographics
NPI:1558434738
Name:HCMH DIVERSIFIED MANAGEMENT CORP
Entity Type:Organization
Organization Name:HCMH DIVERSIFIED MANAGEMENT CORP
Other - Org Name:HCMH OUTPATIENT NEIGHBORHOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:765-529-3313
Mailing Address - Street 1:1000 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-4319
Mailing Address - Country:US
Mailing Address - Phone:765-521-1483
Mailing Address - Fax:765-593-2428
Practice Address - Street 1:1000 N 16TH ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4319
Practice Address - Country:US
Practice Address - Phone:765-521-1483
Practice Address - Fax:765-593-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
IN60005279A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200176100AMedicaid
2024028OtherPK