MEDICARE: HIGHLAND MANOR HEALTHCARE

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	:	1548339245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHLAND MANOR HEALTHCARE

Provider Business Mailing Address
First Line	:	2926 N CAPITOL AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-5131
Country	:	US
Telephone Number	:	317-441-8154
Fax Number	:

Provider Business Practice Location Address
First Line	:	2926 N CAPITOL AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-5131
Country	:	US
Telephone Number	:	317-441-8154
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. VINCENT EDWARD GROGG
Credential	:
Telephone Number	:	317-441-8154

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	08/22/2020

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