Provider Demographics
NPI:1710974068
Name:NORTHERN INDIANA INTERIM HEALTHCARE COMPANY LLC
Entity Type:Organization
Organization Name:NORTHERN INDIANA INTERIM HEALTHCARE COMPANY LLC
Other - Org Name:INTERIM HEALTHCARE OF SOUTH BEND, IN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MCGIVNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-233-5186
Mailing Address - Street 1:605 W EDISON RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-8823
Mailing Address - Country:US
Mailing Address - Phone:574-252-5186
Mailing Address - Fax:574-233-5245
Practice Address - Street 1:605 W EDISON RD
Practice Address - Street 2:SUITE H
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8823
Practice Address - Country:US
Practice Address - Phone:574-252-5186
Practice Address - Fax:574-233-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN04006118251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15-7048Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER