Provider Demographics
NPI:1073795290
Name:FAL-MERIDIAN, INC.
Entity Type:Organization
Organization Name:FAL-MERIDIAN, INC.
Other - Org Name:MERIDIAN NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:MANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-635-9500
Mailing Address - Street 1:2102 S MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46225-1923
Mailing Address - Country:US
Mailing Address - Phone:317-786-9426
Mailing Address - Fax:317-786-9428
Practice Address - Street 1:2102 S MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46225-1923
Practice Address - Country:US
Practice Address - Phone:317-786-9426
Practice Address - Fax:317-786-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6205010001Medicare NSC
IN155428Medicare Oscar/Certification