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General NPI Number Information
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NPI Number | 1669422804
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Entity Type | Organization
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Legal Business Name | HERMITAGE MANOR, INC
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2311 S MILLER ST
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City | SHELBYVILLE
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State | IN
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Zip | 46176-9350
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Country | US
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Telephone | 317-398-9777
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 BROAD ST
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City | NEW CASTLE
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State | IN
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Zip | 47362-4228
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Country | US
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Telephone | 765-521-4110
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PAMELA DEPREZ
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Credential |
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Telephone | 765-521-4110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State | IL
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