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Provider Information for 1598761074


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CHARTWELL MIDWEST INDIANA LLC

Organization Subpart: NO

NPI: 1598761074
Last Updated: 2008-01-07
Certification Date:

Details

NameValue
NPI1598761074
Enumeration Date2005-06-21
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: Mrs. SHARI LYNN PENTICUFF RN
Title: General manager
Phone: 3175943333
Mailing Address 4190 RELIABLE PKWY
CHICAGO, IL 60684-0001
United States

Phone: 317-594-3333 | Fax:317-594-3330
 
Primary Practice Address 8040 CASTLEWAY DR
INDIANAPOLIS, IN 46250-1943
United States

Phone: 317-594-3333 | Fax:317-594-3330
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDIN100293000A
Other (non-Medicare)IN1598761074Group Pin
Other (non-Medicare)IN1598761074Rendering PIN
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
No 3336H0001X - Pharmacy - Home Infusion Therapy PharmacyIN60005571A
No 332BP3500X - Durable Medical Equipment & Medical Supplies - Parenteral & Enteral NutritionIN60005571A
Yes 251F00000X - Home Infusion IN050053311