MEDICARE: DYCORA TRANSITIONAL HEALTH - MERRILLVILLE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		IN

General Provider Information

NPI Number	:	1063955524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYCORA TRANSITIONAL HEALTH - MERRILLVILLE LLC

Provider Business Mailing Address
First Line	:	8800 VIRGINIA PL
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-7109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8800 VIRGINIA PL
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-7109
Country	:	US
Telephone Number	:	559-977-3358
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE
Name	:	JULIANNE WILLIAMS
Credential	:
Telephone Number	:	559-977-3358

Provider Enumeration Date	:	11/30/2016
Last Update Date	:	11/30/2016

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