1801963053 NPI number — HOOSIER ENTERPRISES II, INC.

Table of content: (NPI 1801963053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801963053 NPI number — HOOSIER ENTERPRISES II, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOOSIER ENTERPRISES II, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ESPECIALLY KIDZ HEALTH & REHAB CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801963053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9480 PRIORITY WAY WEST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46240-1470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-811-8124
Provider Business Mailing Address Fax Number:
317-818-1022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2325 S MILLER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBYVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46176-9350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-392-3287
Provider Business Practice Location Address Fax Number:
317-398-9707
Provider Enumeration Date:
11/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
INGHAM
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, CEO
Authorized Official Telephone Number:
765-485-8100

Provider Taxonomy Codes

  • Taxonomy code: 3140N1450X , with the licence number:  10 000273 1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100267870C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".