Basic Information
Provider Information | |||||||||
NPI: | 1699740837 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | COMMUNITY HOME HEALTH SERVICES, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
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: | 02/21/2006 | ||||||||
LastUpdateDate: | 06/25/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | COLLINS | ||||||||
AuthorizedOfficialFirstName: | LISA | ||||||||
AuthorizedOfficialMiddleName: | GAYLE | ||||||||
AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 3176214800 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 005265 | IN | Y |   | Agencies | Home Health |   |
ID Information
ID | Type | State | Issuer | Description | 000000005895 | 01 | IN | MPLAN | OTHER | 000000184200 | 01 | IN | ANTHEM BLUE CROSS AND BLU | OTHER | 100272620A | 05 | IN |   | MEDICAID |