Healthcare Provider Details

I. General information

NPI: 1104844141
Provider Name (Legal Business Name): HOOSIER CHRISTIAN VILLAGE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S SUGAR ST
BROWNSTOWN IN
47220-2066
US

IV. Provider business mailing address

621 S SUGAR ST
BROWNSTOWN IN
47220-2066
US

V. Phone/Fax

Practice location:
  • Phone: 812-358-2504
  • Fax: 812-358-2510
Mailing address:
  • Phone: 812-358-2504
  • Fax: 812-358-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number06-000277-1
License Number StateIN

VIII. Authorized Official

Name: MRS. SUSAN MCGHEE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 314-587-7903