Provider Demographics
NPI:1841804192
Name:SAINT ANNE HOME OF THE DIOCESE OF FORT WAYNE-SOUTH BEND
Entity type:Organization
Organization Name:SAINT ANNE HOME OF THE DIOCESE OF FORT WAYNE-SOUTH BEND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-399-3090
Mailing Address - Street 1:1900 RANDALLIA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4632
Mailing Address - Country:US
Mailing Address - Phone:260-399-3090
Mailing Address - Fax:
Practice Address - Street 1:25 VICTORY NOLL DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-9111
Practice Address - Country:US
Practice Address - Phone:260-399-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility