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General NPI Number Information
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NPI Number | 1538158480
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Entity Type | Organization
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Legal Business Name | HERITAGE HOUSE OF SALEM
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 CONNIE AVE
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City | SALEM
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State | IN
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Zip | 47167-2306
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Country | US
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Telephone | 812-883-1877
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CONNIE AVE
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City | SALEM
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State | IN
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Zip | 47167-2306
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Country | US
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Telephone | 812-883-1877
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Fax |
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Authorized Official
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Title or Position | CCO
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Name | MR. PHIL BROWN
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Credential |
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Telephone | 317-398-6809
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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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