Provider Demographics
NPI:1598191553
Name:HOME CARE SUPPORT, INC
Entity Type:Organization
Organization Name:HOME CARE SUPPORT, INC
Other - Org Name:HOME CARE ASSISTANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ALISCH
Authorized Official - Suffix:SR
Authorized Official - Credentials:BSW, CSA
Authorized Official - Phone:574-289-4444
Mailing Address - Street 1:1635 N IRONWOOD DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1847
Mailing Address - Country:US
Mailing Address - Phone:574-289-4444
Mailing Address - Fax:574-247-1564
Practice Address - Street 1:1635 N IRONWOOD DR STE 1
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1847
Practice Address - Country:US
Practice Address - Phone:574-289-4444
Practice Address - Fax:574-247-1564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12-012237-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200974790-AOtherMEDICADE LEGACY PROVIDER NUMBER