MEDICARE: WOODLAWN HOSPITAL

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	310400000X	Assisted Living Facility	060005011	IN
2	314000000X	Skilled Nursing Facility	060005011	IN
3	313M00000X	Nursing Facility/Intermediate Care Facility	060005011	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000097895	OTHER	IN	ANTHEM PIN NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2297	OTHER	IN	RBA HOME NUMBER

General Provider Information

NPI Number	:	1285723734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODLAWN HOSPITAL

Provider Business Mailing Address
First Line	:	337 GRACE VILLAGE DR
Second Line	:
City	:	WINONA LAKE
State	:	IN
Zip	:	46590-5774
Country	:	US
Telephone Number	:	574-372-6200
Fax Number	:	574-372-6386

Provider Business Practice Location Address
First Line	:	337 GRACE VILLAGE DR
Second Line	:
City	:	WINONA LAKE
State	:	IN
Zip	:	46590-5774
Country	:	US
Telephone Number	:	574-372-6200
Fax Number	:	574-372-6386

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	JOHN ALLEY
Credential	:
Telephone Number	:	574-223-3141

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	11/25/2013

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Directions to “WOODLAWN HOSPITAL ” Practice Location

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