Basic Information
| Provider Information | |||||||||
| NPI: | 1730622291 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DYCORA TRANSITIONAL HEALTH - GREENFIELD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 745 N SWOPE ST | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461401332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174629221 | ||||||||
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| Practice Location | |||||||||
| Address1: | 745 N SWOPE ST | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461401332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174629221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2016 | ||||||||
| LastUpdateDate: | 01/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | HAWKINS | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE | ||||||||
| AuthorizedOfficialTelephone: | 3174629221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.