Organization
MEMORIAL HOME CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG CONRAD (VICE PRESIDENT & GENERAL MANAGER)
(574) 647-8777
Entity
Organization
Contact information
Practice address
1942 N OAK RD, PLYMOUTH, IN 46563-3495
(219) 935-4677
Mailing address
3355 DOUGLAS ROAD, SOUTH BEND, IN 46635-1780
(574) 273-2273
(574) 273-5602
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
69000134A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000363705
ANTHEM PROVIDER
IN
05
—
200253800C
—
IN
Enumeration date
11/13/2006
Last updated
06/05/2008
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