Provider Demographics
NPI:1093543050
Name:STRUCTURED FAMILY HOME CARE INC
Entity type:Organization
Organization Name:STRUCTURED FAMILY HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-288-8800
Mailing Address - Street 1:1290 E. IRELAND ROAD
Mailing Address - Street 2:SUITE V100-BOX 300
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614
Mailing Address - Country:US
Mailing Address - Phone:574-288-8800
Mailing Address - Fax:
Practice Address - Street 1:1290 E IRELAND RD STE V100-300
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-3474
Practice Address - Country:US
Practice Address - Phone:574-288-8800
Practice Address - Fax:574-288-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health