1518024645 NPI number — THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY

Table of content: (NPI 1518024645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518024645 NPI number — THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HEALTH AND HOSPITAL CORPORATION OF MARION COUNTY
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:
EAST LAKE NURSING & REHABILITATION
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:
1518024645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 JEANWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKHART
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46514-4769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-264-1133
Provider Business Mailing Address Fax Number:
574-264-3674

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 JEANWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKHART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-264-1133
Provider Business Practice Location Address Fax Number:
574-264-3674
Provider Enumeration Date:
01/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VAN CAMP
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO OF ASC
Authorized Official Telephone Number:
317-788-2500

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  13-000169-1 , 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: 100267100 B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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