Provider Demographics
NPI:1942583786
Name:INDIANA HOME HEALTH PROVIDER, INC.
Entity Type:Organization
Organization Name:INDIANA HOME HEALTH PROVIDER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROD
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLIENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-513-9401
Mailing Address - Street 1:9219 INDIANAPOLIS BLVD
Mailing Address - Street 2:SUITE 101 D
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2562
Mailing Address - Country:US
Mailing Address - Phone:219-513-9401
Mailing Address - Fax:219-595-0027
Practice Address - Street 1:9219 INDIANAPOLIS BLVD
Practice Address - Street 2:SUITE 101 D
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2562
Practice Address - Country:US
Practice Address - Phone:219-513-9401
Practice Address - Fax:219-595-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health