Provider Demographics
NPI:1619970134
Name:FRANCISCAN HEALTH LAFAYETTE
Entity Type:Organization
Organization Name:FRANCISCAN HEALTH LAFAYETTE
Other - Org Name:FRANCISCAN HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-502-4440
Mailing Address - Street 1:1415 SALEM ST.
Mailing Address - Street 2:SUITE 202W
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2099
Mailing Address - Country:US
Mailing Address - Phone:765-449-5046
Mailing Address - Fax:765-449-5192
Practice Address - Street 1:1415 SALEM ST
Practice Address - Street 2:SUITE 202W
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2099
Practice Address - Country:US
Practice Address - Phone:765-449-5046
Practice Address - Fax:765-449-5192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN HEALTH LAFAYETTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-30
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN005313251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100263950AMedicaid
IL100263950BMedicaid
157124Medicare Oscar/Certification