Healthcare Provider Details

I. General information

NPI: 1093700544
Provider Name (Legal Business Name): HOOSIER CARE II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 E HENDRIX ST
BRAZIL IN
47834-1542
US

IV. Provider business mailing address

535 W 2ND ST STE 105
LEXINGTON KY
40508-1284
US

V. Phone/Fax

Practice location:
  • Phone: 812-443-4111
  • Fax: 859-281-5150
Mailing address:
  • Phone: 859-255-0075
  • Fax: 859-281-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRENDA CAMPBELL
Title or Position: ACCOUNTS RECEIVABLE MANAGER
Credential:
Phone: 859-255-0075