Basic Information
| Provider Information | |||||||||
| NPI: | 1437357662 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAVIESS COUNTY HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEW ALBANY NURSING AND REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1314 E WALNUT ST | ||||||||
| Address2: | P.O. BOX 760 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475012860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122542760 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 E ELM ST | ||||||||
| Address2: | |||||||||
| City: | NEW ALBANY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471503428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129459517 | ||||||||
| FaxNumber: | 8129813303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 01/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | STEINER | ||||||||
| AuthorizedOfficialFirstName: | DERON | ||||||||
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| AuthorizedOfficialTitleorPosition: | BOARD CHAIR | ||||||||
| AuthorizedOfficialTelephone: | 8122542760 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 01/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3140N1450X | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | Nursing Care, Pediatric | 314000000X | IN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 200120200 | 05 | IN | MEDICAID |