Provider Demographics
NPI:1851470157
Name:FAMILY HOSPICE OF NORTHEAST INDIANA INC
Entity Type:Organization
Organization Name:FAMILY HOSPICE OF NORTHEAST INDIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUEANN
Authorized Official - Middle Name:MCDONNA
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-589-8598
Mailing Address - Street 1:108 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711-2118
Mailing Address - Country:US
Mailing Address - Phone:260-589-8598
Mailing Address - Fax:260-589-8079
Practice Address - Street 1:108 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711-2118
Practice Address - Country:US
Practice Address - Phone:260-589-8598
Practice Address - Fax:260-589-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060102121251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000111173OtherBLUE CROSS BLUE SHIELD
IN200163790AMedicaid
IN000000111173OtherBLUE CROSS BLUE SHIELD