Provider Demographics
NPI:1992770028
Name:GREENE COUNTY HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:GREENE COUNTY HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT HHC BOARD
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:812-847-5213
Mailing Address - Street 1:1185 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-5282
Mailing Address - Country:US
Mailing Address - Phone:812-847-9496
Mailing Address - Fax:812-847-1825
Practice Address - Street 1:409 A ST NE
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-1907
Practice Address - Country:US
Practice Address - Phone:812-847-9496
Practice Address - Fax:812-847-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN005324251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE200447480Medicaid
IN200435780Medicaid
NE200447470Medicaid
NE252373OtherANTHEM
IN157148Medicare ID - Type Unspecified