Provider Demographics
NPI:1932105830
Name:INDIANA HOME HEALTH CARE CORP.
Entity Type:Organization
Organization Name:INDIANA HOME HEALTH CARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-334-1857
Mailing Address - Street 1:3800 W GIFFORD RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2612
Mailing Address - Country:US
Mailing Address - Phone:812-334-1857
Mailing Address - Fax:812-330-4288
Practice Address - Street 1:3800 W GIFFORD RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2612
Practice Address - Country:US
Practice Address - Phone:812-334-1857
Practice Address - Fax:812-330-4288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15-7094Medicare ID - Type Unspecified