Provider Demographics
NPI:1992963078
Name:WASHINGTON HEALTH CARE CENTER LLC
Entity type:Organization
Organization Name:WASHINGTON HEALTH CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:IDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-670-1577
Mailing Address - Street 1:5430 W US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-8803
Mailing Address - Country:US
Mailing Address - Phone:317-894-3301
Mailing Address - Fax:317-894-5626
Practice Address - Street 1:5430 W US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-8803
Practice Address - Country:US
Practice Address - Phone:317-894-3301
Practice Address - Fax:317-894-5626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility