Provider Demographics
NPI:1265820047
Name:INDIANA SIGNAL HEALTH GROUP SKILLED
Entity type:Organization
Organization Name:INDIANA SIGNAL HEALTH GROUP SKILLED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-238-9177
Mailing Address - Street 1:PO BOX 15127
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5127
Mailing Address - Country:US
Mailing Address - Phone:765-238-1381
Mailing Address - Fax:303-845-8598
Practice Address - Street 1:2013 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1214
Practice Address - Country:US
Practice Address - Phone:800-260-6145
Practice Address - Fax:888-681-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-02
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN14-013593-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201284430AMedicaid