Provider Demographics
NPI:1649007543
Name:CHARLES FORD MEMORIAL HOME INC
Entity type:Organization
Organization Name:CHARLES FORD MEMORIAL HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:HFA
Authorized Official - Phone:812-682-4675
Mailing Address - Street 1:105 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-2223
Mailing Address - Country:US
Mailing Address - Phone:866-238-2220
Mailing Address - Fax:
Practice Address - Street 1:105 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-2223
Practice Address - Country:US
Practice Address - Phone:866-238-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES FORD MEMORIAL HOME INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based