Healthcare Provider Details

I. General information

NPI: 1992963078
Provider Name (Legal Business Name): WASHINGTON HEALTH CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 W US HIGHWAY 40
GREENFIELD IN
46140-8803
US

IV. Provider business mailing address

5430 W US HIGHWAY 40
GREENFIELD IN
46140-8803
US

V. Phone/Fax

Practice location:
  • Phone: 317-894-3301
  • Fax: 317-894-5626
Mailing address:
  • Phone: 317-894-3301
  • Fax: 317-894-5626

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: MR. MARK ROGER IDE
Title or Position: OWNER
Credential:
Phone: 317-670-1577