Organization
SENIOR HAVEN HOME CARE
Active
Other names
Home Instead Senior Care
Organization subpart
No
Provider details
NPI number
Authorized official
RACHEL ANN MCDERMOTT PTA (OWNER/PRESIDENT)
(563) 599-7674
Entity
Organization
Contact information
Practice address
513 PINE LAKE AVE, LA PORTE, IN 46350-2316
(219) 326-1082
(219) 326-1413
Mailing address
513 PINE LAKE AVE, LA PORTE, IN 46350-2316
(219) 326-1082
(219) 326-1413
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
IC 16-27-4
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201364430
MEDICAID LPI
IN
01
—
IC-16-27-4
PERSONAL SERVICES AGENCY LICENSE
IN
Enumeration date
12/06/2016
Last updated
12/06/2016
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