Healthcare Provider Details

I. General information

NPI: 1407849185
Provider Name (Legal Business Name): LEBANON HEALTH ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 LAKESHORE DR
LEBANON IN
46052-3100
US

IV. Provider business mailing address

129 LAKESHORE DR
LEBANON IN
46052-3100
US

V. Phone/Fax

Practice location:
  • Phone: 765-483-8150
  • Fax: 765-485-0624
Mailing address:
  • Phone: 765-483-8150
  • Fax: 765-485-0624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003797A
License Number StateIN

VIII. Authorized Official

Name: MR. JOSEPH PLEWA
Title or Position: PRESIDENT
Credential: MSW, LCSW
Phone: 765-483-8150