Provider Demographics
NPI:1659596336
Name:ELKHART COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:ELKHART COUNTY HEALTH DEPARTMENT
Other - Org Name:HEALTHY BEGINNINGS
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSTETLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-523-2136
Mailing Address - Street 1:608 OAKLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516
Mailing Address - Country:US
Mailing Address - Phone:574-523-2105
Mailing Address - Fax:574-295-6186
Practice Address - Street 1:1400 HUDSON STREET
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516
Practice Address - Country:US
Practice Address - Phone:574-522-0104
Practice Address - Fax:574-522-1902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100112150AMedicaid