Basic Information
| Provider Information | |||||||||
| NPI: | 1174599047 | ||||||||
| 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: | 02/28/2006 | ||||||||
| LastUpdateDate: | 10/18/2007 | ||||||||
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| AuthorizedOfficialLastName: | WESTLUND | ||||||||
| AuthorizedOfficialFirstName: | JESSIE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3176214850 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMMUNITY HOME HEALTH SERVICES, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | R.N. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 009501 | IN | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 000000185368 | 01 | IN | ANTHEM BLUE CROSS AND BLU | OTHER | 200121620A | 05 | IN | MEDICAID | 000000005895 | 01 | IN | MPLAN | OTHER |