MEDICARE: HOOSIER ENTERPRISES V, INC.

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	:	1578628327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOOSIER ENTERPRISES V, INC.

Provider Business Mailing Address
First Line	:	9455 DELEGATES ROW
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-3805
Country	:	US
Telephone Number	:	317-818-1240
Fax Number	:	317-818-1240

Provider Business Practice Location Address
First Line	:	3550 CENTRAL AVE
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-2035
Country	:	US
Telephone Number	:	812-379-9669
Fax Number	:	812-378-5248

Authorized Official
Title or Position	:	AR MANAGER
Name	:	WILLIAM MUELLER
Credential	:
Telephone Number	:	317-818-1240

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	08/22/2020

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