Provider Demographics
NPI:1750311080
Name:FRANCISCAN HEALTH INDIANAPOLIS & MOORESVILLE
Entity Type:Organization
Organization Name:FRANCISCAN HEALTH INDIANAPOLIS & MOORESVILLE
Other - Org Name:FRANCISCAN HOSPICE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:SVP POST ACUTE SERVICES AND COMPLIA
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GRYZBEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-865-2092
Mailing Address - Street 1:8111 S EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8601
Mailing Address - Country:US
Mailing Address - Phone:317-865-2092
Mailing Address - Fax:
Practice Address - Street 1:8414 FRANCISCAN LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8751
Practice Address - Country:US
Practice Address - Phone:317-865-2092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN006347251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200040190Medicaid
IN200040190Medicaid