Provider Demographics
NPI:1306384367
Name:SCOTT D. SKINNER INC. DBA COMFORT KEEPERS #307
Entity type:Organization
Organization Name:SCOTT D. SKINNER INC. DBA COMFORT KEEPERS #307
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-427-2269
Mailing Address - Street 1:1803 S CREASY LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4943
Mailing Address - Country:US
Mailing Address - Phone:765-449-9797
Mailing Address - Fax:
Practice Address - Street 1:1803 S CREASY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4943
Practice Address - Country:US
Practice Address - Phone:765-449-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN16-011724-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200878800AMedicaid