Provider Demographics
NPI:1730864588
Name:COMMUNITY CARE HUB OF INDIANA, INC
Entity type:Organization
Organization Name:COMMUNITY CARE HUB OF INDIANA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDAGRIFFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-745-1200
Mailing Address - Street 1:8101 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4163
Mailing Address - Country:US
Mailing Address - Phone:260-745-1200
Mailing Address - Fax:
Practice Address - Street 1:8101 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4163
Practice Address - Country:US
Practice Address - Phone:260-745-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty