Provider Demographics
NPI:1093997074
Name:FAL-TERRE HAUTE, INC.
Entity Type:Organization
Organization Name:FAL-TERRE HAUTE, INC.
Other - Org Name:TERRE HAUTE 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 1:830 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4712
Mailing Address - Country:US
Mailing Address - Phone:812-232-7102
Mailing Address - Fax:812-235-1072
Practice Address - Street 1:830 S 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-4712
Practice Address - Country:US
Practice Address - Phone:812-232-7102
Practice Address - Fax:812-235-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
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
IN155511Medicare Oscar/Certification
IN6204920001Medicare NSC