MEDICARE: HOOSIER CARE

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	3140N1450X	Pediatric Skilled Nursing Facility	0035469	IL

General Provider Information

NPI Number	:	1578676391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOOSIER CARE

Provider Business Mailing Address
First Line	:	535 W 2ND ST STE 105
Second Line	:
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	:	1820 WALTER LAWSON DR
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-2757
Country	:	US
Telephone Number	:	815-633-6636
Fax Number	:	815-633-6387

Authorized Official
Title or Position	:	AR MANAGER
Name	:	MRS. BRENDA CAMPBELL
Credential	:
Telephone Number	:	859-255-0075

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/29/2016

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Directions to “HOOSIER CARE ” Practice Location

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