Independence Care Community Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1951 Issued in OH

Legal business name

INDEPENDENCE CARE COMMUNITY INC

Practice address

1000 Independence Rd
Fostoria, OH 44830

Phone

(419) 435-8505

Fax

(419) 435-0829

NPI assigned

Jul 15, 2005

Organization subpart

Yes

Parent organization

INDEPENDENCE CARE COMMUNITY INC DBA INDEPENDENCE HOUSEAs reported in NPPES

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

Authorized official

Name

Mrs. Bridgett M Gamby-Mundy

Title

Administrator

Phone

(419) 435-8505

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Independence House Doing business as

Part of

Independence Care Community Inc

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201564800000",
    "number": "1689673295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 INDEPENDENCE RD.",
            "city": "FOSTORIA",
            "state": "OH",
            "postal_code": "44830",
            "telephone_number": "419-435-8505",
            "fax_number": "419-435-0829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 INDEPENDENCE RD",
            "city": "FOSTORIA",
            "state": "OH",
            "postal_code": "44830",
            "telephone_number": "419-435-8505",
            "fax_number": "419-435-0829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE CARE COMMUNITY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INDEPENDENCE CARE COMMUNITY INC DBA INDEPENDENCE HOUSE",
        "enumeration_date": "2005-07-15",
        "last_updated": "2008-01-29",
        "status": "A",
        "authorized_official_last_name": "GAMBY-MUNDY",
        "authorized_official_first_name": "BRIDGETT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "419-435-8505",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "1951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0960189",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Independence House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Luke Robert Hohenstein, PHARMD
• Jonathan Howell, OTD, OTR/L
• Lauren Hoying, ATC
• Diane Marie Hudson
• Brittney Huffman, CNP
• Alisa D Ingram, MD
• Jameson Jacobs
• Christina Jones
• Leanne Keckler
• Catherine Kelbley

• Skilled Nursing Facility in Fostoria, OH
• Providers in Fostoria, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2008; 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.