Basic Information
| Provider Information | |||||||||
| NPI: | 1184872772 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BROWN COUNTY HEALTH & LIVING COMMUNITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 WILLOW ST | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474487013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129886666 | ||||||||
| FaxNumber: | 8129886668 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 WILLOW ST | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474487013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129886666 | ||||||||
| FaxNumber: | 8129886668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2008 | ||||||||
| LastUpdateDate: | 09/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8123322265 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CARDON & ASSOCIATES | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 31000374A | IN | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 225X00000X | 31000374A | IN | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.