Provider Demographics
NPI:1811132707
Name:NADINE FISH INC
Entity type:Organization
Organization Name:NADINE FISH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAADC
Authorized Official - Phone:269-325-0000
Mailing Address - Street 1:2816 WILLA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2555
Mailing Address - Country:US
Mailing Address - Phone:269-325-0000
Mailing Address - Fax:269-985-0247
Practice Address - Street 1:1601 W CENTRE AVE LOWR 105
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-6307
Practice Address - Country:US
Practice Address - Phone:269-325-0000
Practice Address - Fax:269-985-0247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care