Provider Demographics
NPI:1316920879
Name:OWENSVILLE CONVALESCENT CENTER
Entity type:Organization
Organization Name:OWENSVILLE CONVALESCENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ERIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-729-7901
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47665-0369
Mailing Address - Country:US
Mailing Address - Phone:812-729-7901
Mailing Address - Fax:812-729-7446
Practice Address - Street 1:HIGHWAY 165 WEST
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47665
Practice Address - Country:US
Practice Address - Phone:812-729-7901
Practice Address - Fax:812-729-7446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN155502Medicare ID - Type Unspecified