Provider Demographics
NPI:1194993188
Name:MIDLAND HOUSE, INC.
Entity type:Organization
Organization Name:MIDLAND HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HAYWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-257-2201
Mailing Address - Street 1:3940 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-5541
Mailing Address - Country:US
Mailing Address - Phone:317-257-2201
Mailing Address - Fax:317-254-2112
Practice Address - Street 1:3940 E 56TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-5541
Practice Address - Country:US
Practice Address - Phone:317-257-2201
Practice Address - Fax:317-254-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN151992Medicare Oscar/Certification
IN151992Medicare PIN