Basic Information
Provider Information | |||||||||
NPI: | 1679746267 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SEASONS HOSPICE & PALLIATIVE CARE OF INDIANA, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ACCENTCARE HOSPICE & PALLIATIVE CARE OF INDIANA | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6400 SHAFER CT | ||||||||
Address2: | STE 700 | ||||||||
City: | ROSEMONT | ||||||||
State: | IL | ||||||||
PostalCode: | 600184914 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8476921000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2629 WATERFRONT PARKWAY EAST DR | ||||||||
Address2: | STE 375 | ||||||||
City: | INDIANAPOLIS | ||||||||
State: | IN | ||||||||
PostalCode: | 462142076 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8664009692 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/04/2008 | ||||||||
LastUpdateDate: | 12/10/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SISCEL | ||||||||
AuthorizedOfficialFirstName: | HEATHER | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VP LEGAL | ||||||||
AuthorizedOfficialTelephone: | 2242210465 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/10/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X |   | IN | Y |   | Agencies | Hospice Care, Community Based |   |
No ID Information.