Provider Demographics
NPI:1447337530
Name:HCMH DIVERSIFIED MANAGEMENT CORPORATION
Entity type:Organization
Organization Name:HCMH DIVERSIFIED MANAGEMENT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:JANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-521-1508
Mailing Address - Street 1:25 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47346-1214
Mailing Address - Country:US
Mailing Address - Phone:765-521-1366
Mailing Address - Fax:765-521-1555
Practice Address - Street 1:25 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47346-1214
Practice Address - Country:US
Practice Address - Phone:765-521-1366
Practice Address - Fax:765-521-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005309A333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4030070003Medicare ID - Type Unspecified