Provider Demographics
NPI:1063969384
Name:TERRE HAUTE SENIOR CARE, LLC
Entity type:Organization
Organization Name:TERRE HAUTE SENIOR CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF BUSINESS DEVELOPM
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GUNTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-471-0050
Mailing Address - Street 1:631 E SPRINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4448
Mailing Address - Country:US
Mailing Address - Phone:812-645-9266
Mailing Address - Fax:812-645-0644
Practice Address - Street 1:631 E SPRINGHILL DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4448
Practice Address - Country:US
Practice Address - Phone:812-645-9266
Practice Address - Fax:812-645-0644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KLIPSCH SENIOR CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN16-013854-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care