NPIMap

Organization Active NPI

Memorial Home Care, Inc.

  • Community/Retail Pharmacy
  • South Bend, IN
National Provider Identifier
1700957362
Registry record updated Jun 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
60004143A Issued in IN
Legal business name
MEMORIAL HOME CARE, INC.
Practice address
714 N Michigan St
South Bend, IN 46601-1035
Phone
(574) 647-7176
Fax
(574) 647-6767
NPI assigned
Nov 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2008

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

Authorized official

Name
Greg Conrad
Title
Vice President & General Manager
Phone
(574) 647-8777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 60004143A IN Primary

Addresses

Primary practice location

714 N Michigan St
South Bend, IN 46601-1035

Mailing address

3355 Douglas Road
South Bend, IN 46635-1780
Phone (574) 273-2273

Other identifiers 2

IdentifierTypeStateIssuer
200000690AMedicaidIN
1521271OtherINANTHEM

National Provider Directory

National Provider Directory
Tax ID family
Memorial Home Care Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212624000000",
    "number": "1700957362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 DOUGLAS ROAD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351780",
            "telephone_number": "574-273-2273",
            "fax_number": "574-273-5602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 N MICHIGAN ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011035",
            "telephone_number": "574-647-7176",
            "fax_number": "574-647-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOME CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2008-06-05",
        "status": "A",
        "authorized_official_last_name": "CONRAD",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "VICE PRESIDENT & GENERAL MANAGER",
        "authorized_official_telephone_number": "574-647-8777"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60004143A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200000690A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "1521271",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 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.