Provider Demographics
NPI:1285723734
Name:WOODLAWN HOSPITAL
Entity type:Organization
Organization Name:WOODLAWN HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-223-3141
Mailing Address - Street 1:337 GRACE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WINONA LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46590-5774
Mailing Address - Country:US
Mailing Address - Phone:574-372-6200
Mailing Address - Fax:574-372-6386
Practice Address - Street 1:337 GRACE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WINONA LAKE
Practice Address - State:IN
Practice Address - Zip Code:46590-5774
Practice Address - Country:US
Practice Address - Phone:574-372-6200
Practice Address - Fax:574-372-6386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060005011310400000X, 313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000097895OtherANTHEM PIN NUMBER
IN100266260AMedicaid
IN2297OtherRBA HOME NUMBER
IN2297OtherRBA HOME NUMBER