NPIMap

Organization Active NPI

Visiting Nurse and Hospice Home Inc

Doing business as Stillwater Hospice

  • Home Health Agency
  • Fort Wayne, IN
National Provider Identifier
1083751002
Registry record updated Jun 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
VISITING NURSE AND HOSPICE HOME INC
Doing business as
Stillwater Hospice
Practice address
5910 Homestead Rd
Fort Wayne, IN 46814-4202
Phone
(260) 435-3222
Fax
(260) 435-3275
NPI assigned
Jan 31, 2007
Last updated
Jun 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Leslie Friedel
Title
Ceo
Phone
(260) 435-3222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X IN Primary

Addresses

Primary practice location

5910 Homestead Rd
Fort Wayne, IN 46814-4202

Mailing address

5910 Homestead Rd
Fort Wayne, IN 46814-4202
Phone (260) 435-3222

Other identifiers 1

IdentifierTypeStateIssuer
100272130AMedicaidIN

Other names 1

  • Stillwater Hospice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071205000295 IN Part A Provider - Home Health Agency 4082703608 Practice locations: Berne, IN; Fort Wayne, IN; Marion, IN; Warsaw, IN
O20090722000760 IN Part B Supplier - Clinic/Group Practice 4082703608 Receives reassigned benefits from 12 practitioners
Practice locations: Fort Wayne, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083751002. Details of each certification follow.

Home health agency certification: CCN 157000

Legal name
VISITING NURSE AND HOSPICE HOME INC
Doing business as
STILLWATER CHRONIC DISEASE MANAGEMENT
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 1, 1966
Last certification
Sep 15, 2021
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Enrollment address
5910 Homestead Rd
Fort Wayne, IN 46814-4202

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Stillwater Chronic Disease ManagementCCN 157000 · All quality measures
Ownership
Non-Profit
Certified
Jul 1, 1966
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Visiting Nurse Hospice Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2514 E DuPont Rd
Ste 120
Fort Wayne, IN 46825
Phone (260) 416-5820

5910 Homestead Rd
Fort Wayne, IN 46814
Phone (260) 435-3222

205 S Washington St
Marion, IN 46952
Phone (765) 668-0885

1515 Provident Dr
Ste 250
Warsaw, IN 46580
Phone (260) 435-3222

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Leslie Friedel Individual Corporate OfficerCeo Aug 20, 2018 100%
Operational/Managerial ControlCeo Aug 20, 2018 100%
Elaine Jones Individual Corporate OfficerCfo Jan 1, 2018
W-2 Managing Employee Apr 10, 2017

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687478400000",
    "number": "1083751002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5910 HOMESTEAD RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468144202",
            "telephone_number": "260-435-3222",
            "fax_number": "260-435-3275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5910 HOMESTEAD RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468144202",
            "telephone_number": "260-435-3222",
            "fax_number": "260-435-3275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISITING NURSE AND HOSPICE HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A",
        "authorized_official_last_name": "FRIEDEL",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "260-435-3222"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100272130A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stillwater Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.