Provider Demographics
NPI:1093700544
Name:HOOSIER CARE II
Entity Type:Organization
Organization Name:HOOSIER CARE II
Other - Org Name:CLAY COUNTY HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-255-0075
Mailing Address - Street 1:535 W 2ND ST
Mailing Address - Street 2:STE 105
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1284
Mailing Address - Country:US
Mailing Address - Phone:859-255-0075
Mailing Address - Fax:859-281-5150
Practice Address - Street 1:1408 E HENDRIX ST
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-1542
Practice Address - Country:US
Practice Address - Phone:812-443-4111
Practice Address - Fax:859-281-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2008-03-28
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
IN0687190003Medicare NSC
IN155227Medicare ID - Type Unspecified