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General NPI Number Information
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NPI Number | 1356516207
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Entity Type | Organization
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Legal Business Name | ANTIQUITY HEALTHCARE
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 1319 ONWARD WAY
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City | SELLERSBURG
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State | IN
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Zip | 47172-9447
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Country | US
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Telephone | 502-889-5868
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Fax | 812-246-1640
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Provider Business Mailing Address
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Address Line | 1319 ONWARD WAY
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City | SELLERSBURG
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State | IN
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Zip | 47172-9447
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Country | US
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Telephone | 502-889-5868
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Fax | 812-246-1640
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. DANA LYNETTE CHAPMAN
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Credential | N.P.
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Telephone | 812-246-1640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 5528P
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 5528P
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 5528P
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License Number State | KY
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