Provider Demographics
NPI:1871682161
Name:BMO HOME HEALTH CARE INC
Entity type:Organization
Organization Name:BMO HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-977-9099
Mailing Address - Street 1:1970 GRANT STREET
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404
Mailing Address - Country:US
Mailing Address - Phone:219-977-9099
Mailing Address - Fax:219-977-9013
Practice Address - Street 1:1970 GRANT STREET
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404
Practice Address - Country:US
Practice Address - Phone:219-977-9099
Practice Address - Fax:219-977-9013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17-009945-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200130560AMedicaid
IN200141880AOtherWAIVER
IN200141880AOtherWAIVER