Basic Information
| Provider Information | |||||||||
| NPI: | 1669466546 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DAVIESS COUNTY HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LAWRENCE MANOR HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1314 WALNUT STREET | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475012860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122542760 | ||||||||
| FaxNumber: | 2607283582 | ||||||||
| Practice Location | |||||||||
| Address1: | 8935 E 46TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462264125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178981515 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 01/02/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STEINER | ||||||||
| AuthorizedOfficialFirstName: | DERON | ||||||||
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| AuthorizedOfficialTitleorPosition: | BOARD CHAIR | ||||||||
| AuthorizedOfficialTelephone: | 8122542760 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 040003831 | IN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 100289610A | 05 | IN | MEDICAID |