Healthcare Provider Details

I. General information

NPI: 1558629972
Provider Name (Legal Business Name): HOOSIER CARE III, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 OGLETOWN STANTON RD
NEWARK DE
19713-2068
US

IV. Provider business mailing address

4949 OGLETOWN STANTON RD
NEWARK DE
19713-2068
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-6900
  • Fax: 302-998-4214
Mailing address:
  • Phone: 302-998-6900
  • Fax: 302-998-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1997116498
License Number StateDE

VIII. Authorized Official

Name: MR. DEAN REID
Title or Position: ADMINISTRATOR
Credential:
Phone: 302-998-6900