MEDICARE: SULLIVAN HEALTH & LIVING CENTER, 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	314000000X	Skilled Nursing Facility		IN

General Provider Information

NPI Number	:	1710952866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SULLIVAN HEALTH & LIVING CENTER, INC.

Provider Business Mailing Address
First Line	:	3249 E COVENANTER DR
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-5479
Country	:	US
Telephone Number	:	812-332-2265
Fax Number	:	812-334-0853

Provider Business Practice Location Address
First Line	:	325 W NORTHWOOD DR
Second Line	:
City	:	SULLIVAN
State	:	IN
Zip	:	47882-7515
Country	:	US
Telephone Number	:	812-268-3351
Fax Number	:	812-268-3765

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	DR. STEPHEN G. MOORE
Credential	:	M. D.
Telephone Number	:	812-332-2265

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	08/22/2020

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