Provider Demographics
NPI:1639904832
Name:NEW OUTLOOK HOME CARE OF NORTHERN INDIANA
Entity type:Organization
Organization Name:NEW OUTLOOK HOME CARE OF NORTHERN INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAST
Authorized Official - Suffix:
Authorized Official - Credentials:CO-OWNER
Authorized Official - Phone:574-849-1174
Mailing Address - Street 1:525 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-9004
Mailing Address - Country:US
Mailing Address - Phone:574-849-1174
Mailing Address - Fax:
Practice Address - Street 1:525 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9004
Practice Address - Country:US
Practice Address - Phone:574-849-1174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care