Provider Demographics
NPI:1851510085
Name:AGING & IN-HOME SERVICES OF NORTHEAST INDIANA, INC.
Entity Type:Organization
Organization Name:AGING & IN-HOME SERVICES OF NORTHEAST INDIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUDOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-745-1200
Mailing Address - Street 1:2927 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2927 LAKE AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5415
Practice Address - Country:US
Practice Address - Phone:260-745-1200
Practice Address - Fax:260-469-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200343870Medicaid