Basic Information
| Provider Information | |||||||||
| NPI: | 1114993490 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY HOME HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9894 E 121ST ST | ||||||||
| Address2: | |||||||||
| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460374154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176214800 | ||||||||
| FaxNumber: | 3176214811 | ||||||||
| Practice Location | |||||||||
| Address1: | 9894 E 121ST ST | ||||||||
| Address2: | |||||||||
| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460374154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176214800 | ||||||||
| FaxNumber: | 3176214811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 07/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | STEWART | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | COO HME | ||||||||
| AuthorizedOfficialTelephone: | 3176214810 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMMUNITY HOME HEALTH SERVICES, INC | ||||||||
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| AuthorizedOfficialCredential: | RRT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332BX2000X | 69000274A | IN | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 3336H0001X | N | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | 251F00000X | 60004988A | IN | N | Agencies | Home Infusion | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 000000214624 | 01 | IN | ANTHEM BLUE CROSS AND BLU | OTHER | 000000011033 | 01 | IN | MPLAN | OTHER | 000000011142 | 01 | IN | MPLAN | OTHER | 200189320A | 05 | IN | MEDICAID | 000000107707 | 01 | IN | ANTHEM BLUE CROSS AND BLU | OTHER |