Basic Information
| Provider Information | |||||||||
| NPI: | 1578528790 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOME CARE SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6202 CONSTITUTION DR | ||||||||
| Address2: | SUITE C | ||||||||
| City: | FT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468041583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604592917 | ||||||||
| FaxNumber: | 2604592894 | ||||||||
| Practice Location | |||||||||
| Address1: | 6202 CONSTITUTION DR | ||||||||
| Address2: | SUITE C | ||||||||
| City: | FT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468041583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604592917 | ||||||||
| FaxNumber: | 2604592894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 11/17/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | EVERSON RN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTI | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/ ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2604592917 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 06-004060-1 | IN | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 200491120A | 05 | IN | MEDICAID |