Provider Demographics
NPI:1306846860
Name:NORTHERN INDIANA INTERIM HEALTHCARE COMPANY LLC
Entity type:Organization
Organization Name:NORTHERN INDIANA INTERIM HEALTHCARE COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BYL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-377-9617
Mailing Address - Street 1:310 E DUPONT RD
Mailing Address - Street 2:STE 1
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2048
Mailing Address - Country:US
Mailing Address - Phone:260-482-9405
Mailing Address - Fax:260-482-7180
Practice Address - Street 1:111 E LUDWIG RD STE 105
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-4240
Practice Address - Country:US
Practice Address - Phone:260-482-9405
Practice Address - Fax:260-482-7180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
IN04-003294-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200398720BMedicaid
IN200 396 990AMedicaid