Provider Demographics
NPI:1053465757
Name:HEALTH & HOSPITAL CORPORATION OF MARION COUNTY
Entity Type:Organization
Organization Name:HEALTH & HOSPITAL CORPORATION OF MARION COUNTY
Other - Org Name:LOCKEFIELD VILLAGE NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUTWEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-221-2009
Mailing Address - Street 1:980 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2915
Mailing Address - Country:US
Mailing Address - Phone:317-269-0448
Mailing Address - Fax:317-655-3880
Practice Address - Street 1:980 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2915
Practice Address - Country:US
Practice Address - Phone:317-269-0448
Practice Address - Fax:317-655-3880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0600008-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherFEDERAL TAX ID NUMBER
IN155021Medicare Oscar/Certification