Provider Demographics
NPI:1689826992
Name:FAMILY HOSPICE OF NORTHEAST INDIANA
Entity Type:Organization
Organization Name:FAMILY HOSPICE OF NORTHEAST INDIANA
Other - Org Name:FAMILY HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-589-8598
Mailing Address - Street 1:265 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711-1547
Mailing Address - Country:US
Mailing Address - Phone:260-589-8598
Mailing Address - Fax:260-589-8065
Practice Address - Street 1:265 W WATER ST
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711-1547
Practice Address - Country:US
Practice Address - Phone:260-589-8598
Practice Address - Fax:260-589-8065
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HOSPICE OF NORTHEAST INDIANA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064091A208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN256410Medicare PIN