Healthcare Provider Details

I. General information

NPI: 1730174434
Provider Name (Legal Business Name): WOODLAWN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31869 CHICAGO TRAIL
NEW CARLISLE IN
46552-9639
US

IV. Provider business mailing address

31869 CHICAGO TRAIL
NEW CARLISLE IN
46552-9639
US

V. Phone/Fax

Practice location:
  • Phone: 574-654-2200
  • Fax: 574-654-2219
Mailing address:
  • Phone: 574-654-2200
  • Fax: 574-654-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number StateIN

VIII. Authorized Official

Name: MR. JOHN ALLEY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 574-223-3141