Healthcare Provider Details

I. General information

NPI: 1740270701
Provider Name (Legal Business Name): SOUTHWIND HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S 2ND ST
BOONVILLE IN
47601-1961
US

IV. Provider business mailing address

725 S 2ND ST
BOONVILLE IN
47601-1961
US

V. Phone/Fax

Practice location:
  • Phone: 812-897-1375
  • Fax: 812-897-5152
Mailing address:
  • Phone: 812-897-1375
  • Fax: 812-897-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUDITH KAREN CARTER
Title or Position: ADMINISTRATOR
Credential: HFA
Phone: 812-897-1375