Basic Information
| Provider Information | |||||||||
| NPI: | 1659452449 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AMERICARE LIVING CENTERS III, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | TRINITY VILLAGE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 S WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473052459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652822889 | ||||||||
| FaxNumber: | 7652815530 | ||||||||
| Practice Location | |||||||||
| Address1: | 4301 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477140678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124778971 | ||||||||
| FaxNumber: | 8124713258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SANDEFUR | ||||||||
| AuthorizedOfficialFirstName: | DEENA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CORPORATE A/R MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7652822889 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | IN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.