Provider Demographics
NPI:1790046795
Name:PEAK HOME HEALTH LLC
Entity Type:Organization
Organization Name:PEAK HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:OGLESBY ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:219-472-9820
Mailing Address - Street 1:8684 CONNECTICUT ST
Mailing Address - Street 2:SUITE A2
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5580
Mailing Address - Country:US
Mailing Address - Phone:219-472-9820
Mailing Address - Fax:219-472-9821
Practice Address - Street 1:8684 CONNECTICUT ST
Practice Address - Street 2:SUITE A2
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5580
Practice Address - Country:US
Practice Address - Phone:219-472-9820
Practice Address - Fax:219-472-9821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120128881251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN120128881OtherSTATE LICENSURE