Provider Demographics
NPI:1679671697
Name:MUNSTER MEDICAL RESEARCH FOUNDATION, INC.
Entity Type:Organization
Organization Name:MUNSTER MEDICAL RESEARCH FOUNDATION, INC.
Other - Org Name:COMMUNITY HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KULLERSTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-934-8999
Mailing Address - Street 1:PO BOX 3602
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-0756
Mailing Address - Country:US
Mailing Address - Phone:219-934-8888
Mailing Address - Fax:219-934-8889
Practice Address - Street 1:901 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-836-1600
Practice Address - Fax:219-934-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-009830-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200121810AMedicaid
IN200121810AMedicaid