Provider Demographics
NPI:1902075062
Name:ANCHOR HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:ANCHOR HEALTH SYSTEMS, INC.
Other - Org Name:ANCHOR HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-662-3500
Mailing Address - Street 1:1351 SILHAVY RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-9513
Mailing Address - Country:US
Mailing Address - Phone:219-662-3500
Mailing Address - Fax:219-246-2544
Practice Address - Street 1:1351 SILHAVY RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-9513
Practice Address - Country:US
Practice Address - Phone:219-662-3500
Practice Address - Fax:219-246-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN070053361251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100264430AMedicaid
IN15-7163Medicare UPIN