Provider Demographics
NPI:1396083341
Name:FOSTER HOMECARE OF NORTHERN INDIANA LLC
Entity type:Organization
Organization Name:FOSTER HOMECARE OF NORTHERN INDIANA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:J
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-514-9470
Mailing Address - Street 1:3029 WOODMONT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-2246
Mailing Address - Country:US
Mailing Address - Phone:574-514-9470
Mailing Address - Fax:
Practice Address - Street 1:3029 WOODMONT DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-2246
Practice Address - Country:US
Practice Address - Phone:574-514-9470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-26
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care