Provider Demographics
NPI:1689626665
Name:COMMUNITY HOME HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:COMMUNITY HOME HEALTH CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:219-324-5005
Mailing Address - Street 1:240 COMMERCE SQ
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3282
Mailing Address - Country:US
Mailing Address - Phone:219-324-5005
Mailing Address - Fax:219-736-1385
Practice Address - Street 1:240 COMMERCE SQ
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3282
Practice Address - Country:US
Practice Address - Phone:219-324-5005
Practice Address - Fax:219-736-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-002684-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200323290AMedicaid
IN157533Medicare ID - Type UnspecifiedHOME HEALTH CARE PROVIDER