Provider Demographics
NPI:1598159113
Name:SHORELINE PARTNERSHIPS INC DBA COMFORT KEEPERS #904
Entity Type:Organization
Organization Name:SHORELINE PARTNERSHIPS INC DBA COMFORT KEEPERS #904
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:812-372-2222
Mailing Address - Street 1:1001 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5717
Mailing Address - Country:US
Mailing Address - Phone:812-372-2222
Mailing Address - Fax:812-372-2226
Practice Address - Street 1:1001 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5717
Practice Address - Country:US
Practice Address - Phone:812-372-2222
Practice Address - Fax:812-372-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN14-013453-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN14-013453-1OtherPERSONAL SERVICE AGENCY LICENSE