Organization
KOSCIUSKO HOME CARE & HOSPICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD R PACZKOWSKI (ADMINISTRATOR)
(574) 372-3401
Entity
Organization
Contact information
Practice address
1515 PROVIDENT DR, SUITE 250, WARSAW, IN 46580-3294
(574) 372-3401
(574) 372-3415
Mailing address
1515 PROVIDENT DR, SUITE 250, WARSAW, IN 46580-3294
(574) 372-3401
(574) 372-3415
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
080052681
IN
251G00000X
Community Based Hospice Care Agency
Primary
070095111
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100272790
—
IN
05
—
100272800
—
IN
01
—
174186
ANTHEM BCBS
—
05
—
200297120
—
IN
Enumeration date
01/18/2007
Last updated
05/27/2009
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