Provider Demographics
NPI:1780671990
Name:PHYSICIANS HOMECARE, INC
Entity Type:Organization
Organization Name:PHYSICIANS HOMECARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADLON
Authorized Official - Middle Name:L
Authorized Official - Last Name:DRAYER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:765-447-3443
Mailing Address - Street 1:210 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5105
Mailing Address - Country:US
Mailing Address - Phone:765-447-3443
Mailing Address - Fax:765-447-5877
Practice Address - Street 1:210 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5105
Practice Address - Country:US
Practice Address - Phone:765-447-3443
Practice Address - Fax:765-447-5877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-005352-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200045230AMedicaid
IN100265450AMedicaid
IN100265450AMedicaid