Healthcare Provider Details

I. General information

NPI: 1346356805
Provider Name (Legal Business Name): INDIAN CREEK HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W EDISON AVE
NEW CASTLE PA
16101-2174
US

IV. Provider business mailing address

23700 COMMERCE PARK
BEACHWOOD OH
44122-5827
US

V. Phone/Fax

Practice location:
  • Phone: 724-652-6340
  • Fax: 724-656-1170
Mailing address:
  • Phone: 216-292-5706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number025902
License Number StatePA

VIII. Authorized Official

Name: WILLIAM WEISBERG
Title or Position: PRESIDENT
Credential:
Phone: 216-292-5706