Provider Demographics
NPI:1710542154
Name:INTERIM HEALTHCARE HOSPICE OF INDIANA, INC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE HOSPICE OF INDIANA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-436-9404
Mailing Address - Street 1:300 W WILSON BRIDGE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2289
Mailing Address - Country:US
Mailing Address - Phone:614-436-9404
Mailing Address - Fax:
Practice Address - Street 1:5410 CHARLESTOWN ROAD
Practice Address - Street 2:UNIT 2
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150
Practice Address - Country:US
Practice Address - Phone:930-888-2110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based