NPIMap

Organization Active NPI

Charlie Bob, LLC

  • In Home Supportive Care Agency
  • Fort Wayne, IN
National Provider Identifier
1295119154
Registry record updated Jul 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
CHARLIE BOB, LLC
Practice address
5202 Saint Joe Rd
Suite 118
Fort Wayne, IN 46835-3380
Phone
(260) 918-9525
NPI assigned
Jul 10, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2015

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

Authorized official

Name
Charles Packer
Title
Owner/Ceo
Phone
(574) 265-1568

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X Primary

Addresses

Primary practice location

5202 Saint Joe Rd
Suite 118
Fort Wayne, IN 46835-3380

Mailing address

5202 Saint Joe Rd
Suite 118
Fort Wayne, IN 46835-3380
Phone (260) 918-9525

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1436486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436486400000",
    "number": "1295119154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5202 SAINT JOE RD",
            "address_2": "SUITE 118",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468353380",
            "telephone_number": "260-918-9525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5202 SAINT JOE RD",
            "address_2": "SUITE 118",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468353380",
            "telephone_number": "260-918-9525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLIE BOB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-10",
        "last_updated": "2015-07-10",
        "status": "A",
        "authorized_official_last_name": "PACKER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "574-265-1568"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.