Individual
TARA EUGENIA MATHIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1657 COMMERCE DR STE 8B, SOUTH BEND, IN 46628-1542
(574) 367-0395
(844) 894-8398
Mailing address
20200 MILLER RD, SOUTH BEND, IN 46614-9432
(574) 367-0395
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61-1857998
INTERNAL REVENUE SERVICES
IN
05
—
61-1857998
—
IN
Enumeration date
07/10/2024
Last updated
07/26/2024
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