Healthcare Provider Details

I. General information

NPI: 1073557617
Provider Name (Legal Business Name): WOODLAWN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 EAST ST
NORTH MANCHESTER IN
46962-9654
US

IV. Provider business mailing address

PO BOX 501
NORTH MANCHESTER IN
46962-0501
US

V. Phone/Fax

Practice location:
  • Phone: 260-982-2118
  • Fax: 260-982-4385
Mailing address:
  • Phone: 260-982-2118
  • Fax: 260-982-4385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number06-000448-1
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number06-000448-1
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number06-000448-1
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number06-000448-1
License Number StateIN

VIII. Authorized Official

Name: MS. SABINE THOMAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 260-982-3939