Provider Demographics
NPI:1760779078
Name:PHYSIOCARE HOSPICE LLC
Entity Type:Organization
Organization Name:PHYSIOCARE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:RADICS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-787-1570
Mailing Address - Street 1:625 S EARL AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-3605
Mailing Address - Country:US
Mailing Address - Phone:765-838-1660
Mailing Address - Fax:765-838-1662
Practice Address - Street 1:1440 INNOVATION PL
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1000
Practice Address - Country:US
Practice Address - Phone:765-250-3827
Practice Address - Fax:765-250-3842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based