Healthcare Provider Details

I. General information

NPI: 1508960535
Provider Name (Legal Business Name): ST. CLARE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 LAFAYETTE RD
CRAWFORDSVILLE IN
47933-1033
US

IV. Provider business mailing address

1710 LAFAYETTE RD
CRAWFORDSVILLE IN
47933-1033
US

V. Phone/Fax

Practice location:
  • Phone: 765-362-2800
  • Fax:
Mailing address:
  • Phone: 765-362-2800
  • Fax:

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: JEFFREY C ZEH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 765-362-3100