Basic Information
| Provider Information | |||||||||
| NPI: | 1639244163 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN SENIOR HOME CARE OF FT WAYNE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6900 GRAY RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462373209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177882500 | ||||||||
| FaxNumber: | 3177804688 | ||||||||
| Practice Location | |||||||||
| Address1: | 6900 GRAY RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462373209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177882500 | ||||||||
| FaxNumber: | 3177804688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 06/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | BURKHART | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3177882500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.