Provider Demographics
NPI:1992359632
Name:HIH FORT WAYNE, LLC D/B/A
Entity Type:Organization
Organization Name:HIH FORT WAYNE, LLC D/B/A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-633-2005
Mailing Address - Street 1:820 MILL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-6400
Mailing Address - Country:US
Mailing Address - Phone:260-633-2005
Mailing Address - Fax:260-338-2536
Practice Address - Street 1:820 MILL LAKE RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-6400
Practice Address - Country:US
Practice Address - Phone:260-633-2005
Practice Address - Fax:260-338-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN19-014687-1OtherPRIVATE PAY AND VA