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Organization subpart
No

Provider details

NPI number
Authorized official
MR. JIMMY DALE GRIMES ADMINISTRATOR (PRESIDENT/CEO)
(574) 855-1536
Entity
Organization

Contact information

Practice address
16462 SHAMROCK DR, MISHAWAKA, IN 46544-6491
(574) 855-1536
(574) 855-1099
Mailing address
16462 SHAMROCK DR, MISHAWAKA, IN 46544-6491
(574) 855-1536
(574) 855-1099

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
10-012231-1
IN

Other

Enumeration date
06/03/2010
Last updated
06/03/2010
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