MEDICARE: MLB MERIDIAN HEALTH FACILITIES, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902801574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MLB MERIDIAN HEALTH FACILITIES, INC

Provider Business Mailing Address
First Line	:	2102 S MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46225-1923
Country	:	US
Telephone Number	:	317-786-9426
Fax Number	:	317-786-9428

Provider Business Practice Location Address
First Line	:	2102 S MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46225-1923
Country	:	US
Telephone Number	:	317-786-9426
Fax Number	:	317-786-9428

Authorized Official
Title or Position	:	CFO
Name	:	WILLIAM MANDO
Credential	:
Telephone Number	:	813-635-9500

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	08/22/2020

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