1316920879 NPI number — OWENSVILLE CONVALESCENT CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316920879 NPI number — OWENSVILLE CONVALESCENT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OWENSVILLE CONVALESCENT CENTER
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:
Provider Other Organization Name Type Code:
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:
1316920879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 369
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWENSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47665-0369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-729-7901
Provider Business Mailing Address Fax Number:
812-729-7446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HIGHWAY 165 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-729-7901
Provider Business Practice Location Address Fax Number:
812-729-7446
Provider Enumeration Date:
11/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ERIC
Authorized Official First Name:
WILL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
812-729-7901

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , 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)





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