Provider Demographics
NPI:1811086044
Name:BOARD OF COMMISSIONERS OF NEWTON COUNTY
Entity type:Organization
Organization Name:BOARD OF COMMISSIONERS OF NEWTON COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HFA
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:RAY SCOTT
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-275-2531
Mailing Address - Street 1:3623 E STATE ROAD 16
Mailing Address - Street 2:
Mailing Address - City:BROOK
Mailing Address - State:IN
Mailing Address - Zip Code:47922-8800
Mailing Address - Country:US
Mailing Address - Phone:219-275-2531
Mailing Address - Fax:219-275-7472
Practice Address - Street 1:3623 E STATE ROAD 16
Practice Address - Street 2:
Practice Address - City:BROOK
Practice Address - State:IN
Practice Address - Zip Code:47922-8800
Practice Address - Country:US
Practice Address - Phone:219-275-2531
Practice Address - Fax:219-275-7472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN050005591314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100267170OtherAIM
IN100267170OtherAIM