REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME NPI 1548614910

NPI Information

REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME is a hospice care community based in Saint John, IN. REST HAVEN ILLIANA CHRISTIAN CONVALESCENT HOME NPI is 1548614910. The provider is registered as an organization entity type.
The provider Is Doing Business As Providence Life Services.

The provider's business location address is:

10700 PARK PL
SAINT JOHN, IN
ZIP 46373-666
Phone: (800) 509-2800
Fax: (708) 342-8006

The provider's authorized official is Johanna Zandstra .
The authorized official title is Vice President Of Operations and has the following contact phone number (708) 342-8100.

The CLIA number assigned to this NPI record is 14D0884774 - home health agency with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/21/2016 and was last updated on 1/23/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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