Provider Demographics
NPI:1699427245
Name:TRANSITIONS FORT WAYNE, LLC
Entity type:Organization
Organization Name:TRANSITIONS FORT WAYNE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCFO
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-515-1505
Mailing Address - Street 1:8913 N PRAIRIE POINTE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1577
Mailing Address - Country:US
Mailing Address - Phone:847-515-1505
Mailing Address - Fax:
Practice Address - Street 1:2865 E DUPONT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1668
Practice Address - Country:US
Practice Address - Phone:847-515-1505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based