Provider Demographics
NPI:1427473198
Name:LADIM HOME CARE SERVICES INC.
Entity type:Organization
Organization Name:LADIM HOME CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MOSUNMOLA
Authorized Official - Middle Name:KARAMAT
Authorized Official - Last Name:OKENLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-276-4962
Mailing Address - Street 1:5246 HOHMAN AVE
Mailing Address - Street 2:SUITE 307C
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-1733
Mailing Address - Country:US
Mailing Address - Phone:219-276-4962
Mailing Address - Fax:
Practice Address - Street 1:5246 HOHMAN AVE
Practice Address - Street 2:SUITE 307C
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-2248
Practice Address - Country:US
Practice Address - Phone:219-276-4962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN14-013323-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN14-013323-1Medicaid