MEDICARE: HOOSIER CARE II

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	:	1093700544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOOSIER CARE II

Provider Business Mailing Address
First Line	:	535 W 2ND ST
Second Line	:	STE 105
City	:	LEXINGTON
State	:	KY
Zip	:	40508-1284
Country	:	US
Telephone Number	:	859-255-0075
Fax Number	:	859-281-5150

Provider Business Practice Location Address
First Line	:	1408 E HENDRIX ST
Second Line	:
City	:	BRAZIL
State	:	IN
Zip	:	47834-1542
Country	:	US
Telephone Number	:	812-443-4111
Fax Number	:	859-281-5150

Authorized Official
Title or Position	:	ACCOUNTS RECEIVABLE MANAGER
Name	:	BRENDA CAMPBELL
Credential	:
Telephone Number	:	859-255-0075

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	03/28/2008

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Directions to “HOOSIER CARE II ” Practice Location

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