NPIMap

Organization Active NPI

Pediatric, Infant & Family Home Health Care Specialists, Inc

  • Home Health Agency
  • Gary, IN
National Provider Identifier
1285701235
Registry record updated Jan 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PEDIATRIC, INFANT & FAMILY HOME HEALTH CARE SPECIALISTS, INC
Practice address
1512 Burr St
Gary, IN 46406-2369
Phone
(219) 949-7696
Fax
(219) 949-7694
NPI assigned
Nov 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2011

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

Authorized official

Name
Linda Lewis
Title
Administrator
Phone
(219) 949-7696

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

1512 Burr St
Gary, IN 46406-2369

Mailing address

1512 Burr St
Gary, IN 46406-2369
Phone (219) 949-7696

Other identifiers 3

IdentifierTypeStateIssuer
000000263283OtherINANTHEM
200156590MedicaidIN
200161910MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110419000800 IN Part A Provider - Home Health Agency 3678758513 Practice locations: Gary, IN

Home health agency certification: CCN 157523

Legal name
PEDIATRIC, INFANT & FAMILY HOME HEALTH CARE SPECIALISTS, INC
Doing business as
PEDIATRIC INFANT & FAMILY PERSONAL CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 23, 1998
Last certification
Sep 16, 2021
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Jul 1, 1997 in IN
Enrollment address
1512 Burr St
Gary, IN 46406-2369

Care Compare: Home health agency

Medicare Care Compare
Listed as
Pediatric Infant & Family Personal Care SpecialCCN 157523 · All quality measures
Ownership
Proprietary
Certified
Sep 23, 1998
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D0950862Pediatric Infant & Family Home1512 Burr St, Gary, IN 46406Certificate of waiverSep 8, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Walter Lewis Individual 5% Or Greater Direct Ownership Interest Apr 6, 2020 25%
5% Or Greater Mortgage Interest Apr 6, 2020 25%
Shawnta Ford Individual 5% Or Greater Direct Ownership Interest Apr 6, 2020 12.5%
5% Or Greater Mortgage Interest Apr 6, 2020 12.5%
Frances Holmes Individual 5% Or Greater Direct Ownership Interest Oct 3, 2003 50%
5% Or Greater Mortgage Interest Jul 1, 2003 50%
General Partnership Interest Oct 23, 2003 50%
Corporate Officer Oct 3, 2003 50%
Corporate Director Oct 23, 2003 50%
W-2 Managing Employee Apr 6, 2020 50%
Kimberly Williamson Individual 5% Or Greater Direct Ownership Interest Apr 6, 2020 12.5%
5% Or Greater Mortgage Interest Apr 6, 2020 12.5%

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294790400000",
    "number": "1285701235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 BURR ST",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464062369",
            "telephone_number": "219-949-7696",
            "fax_number": "219-949-7694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 BURR ST",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464062369",
            "telephone_number": "219-949-7696",
            "fax_number": "219-949-7694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC, INFANT & FAMILY HOME HEALTH CARE SPECIALISTS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2011-01-12",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "219-949-7696"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000263283",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200156590",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200161910",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gary, IN

Sources for this page

Verify at the official NPI Registry.