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General NPI Number Information
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NPI Number | 1366982928
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Entity Type | Organization
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Legal Business Name | DYCORA TRANSITIONAL HEALTH - WILLOW SPRINGS LLC
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 2002 W 86TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1903
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Country | US
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Telephone | 559-977-3358
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 W 86TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1903
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE
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Name | JULIANNE WILLIAMS
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Credential |
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Telephone | 559-977-3358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | IN
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