Provider Demographics
NPI:1962585430
Name:HEART TO HEART HOSPICE OF SOUTHWEST INDIANA LLC
Entity type:Organization
Organization Name:HEART TO HEART HOSPICE OF SOUTHWEST INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:O
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-517-6300
Mailing Address - Street 1:7240 CHASE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-5901
Mailing Address - Country:US
Mailing Address - Phone:972-517-6300
Mailing Address - Fax:972-517-2014
Practice Address - Street 1:415 E 6TH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546
Practice Address - Country:US
Practice Address - Phone:812-482-2012
Practice Address - Fax:812-482-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06-005816-1251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200148960Medicaid
IN151514Medicare Oscar/Certification