MEDICARE: HOOSIER CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility	0035469	IL

General Provider Information

NPI Number	:	1346295631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOOSIER CARE, INC.

Provider Business Mailing Address
First Line	:	1820 WALTER LAWSON DR
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-2757
Country	:	US
Telephone Number	:	815-633-6636
Fax Number	:	815-633-6387

Provider Business Practice Location Address
First Line	:	1820 WALTER LAWSON DR
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-2757
Country	:	US
Telephone Number	:	815-633-6636
Fax Number	:	815-633-6387

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. THEO ANN BRANDEL
Credential	:	R.N.
Telephone Number	:	815-633-6636

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	08/22/2020

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Directions to “HOOSIER CARE, INC. ” Practice Location

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