Provider Demographics
NPI:1851770226
Name:PREMIER HOSPICE & PALLIATIVE CARE - INDIANA, LLC
Entity Type:Organization
Organization Name:PREMIER HOSPICE & PALLIATIVE CARE - INDIANA, LLC
Other - Org Name:ADORATION HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-810-1079
Mailing Address - Street 1:10315 DAWSONS CREEK BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1912
Mailing Address - Country:US
Mailing Address - Phone:206-782-3333
Mailing Address - Fax:206-782-3334
Practice Address - Street 1:10315 DAWSONS CREEK BLVD
Practice Address - Street 2:UNIT J
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1912
Practice Address - Country:US
Practice Address - Phone:206-782-3333
Practice Address - Fax:206-782-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based