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
714 N MICHIGAN ST, SOUTH BEND, IN 46601-1035
(574) 647-7176
(574) 647-6767
Mailing address
3355 DOUGLAS ROAD, SOUTH BEND, IN 46635-1780
(574) 273-2273
(574) 273-5602
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
60004143A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1521271
ANTHEM
IN
05
—
200000690A
—
IN
Enumeration date
11/13/2006
Last updated
06/05/2008
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