Theresa Lynn Petruska, MSW, LSW

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

33007071A Issued in IN

Practice address

4795 Broadway
Suite a
Gary, IN 46409-2403

Phone

(219) 980-6217

Fax

(219) 985-6772

NPI assigned

Sep 11, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1441929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441929600000",
    "number": "1922476605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 MISSISSIPPI ST",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464091235",
            "telephone_number": "219-718-7626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4795 BROADWAY",
            "address_2": "SUITE A",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464092403",
            "telephone_number": "219-980-6217",
            "fax_number": "219-985-6772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUSKA",
        "first_name": "THERESA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "MSW, LSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-11",
        "last_updated": "2015-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "IN",
            "license": "33007071A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• In Home Supportive Care Agency in Gary, IN
• Providers in Gary, IN by specialty
• In Home Supportive Care Agency in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.