Provider Demographics
NPI:1114916806
Name:DUKES MEMORIAL HOSPITAL-CONTINUING CARE CENTER
Entity Type:Organization
Organization Name:DUKES MEMORIAL HOSPITAL-CONTINUING CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:KERRIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HANAWALT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:765-472-8000
Mailing Address - Street 1:275 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-1638
Mailing Address - Country:US
Mailing Address - Phone:765-472-8000
Mailing Address - Fax:765-473-0005
Practice Address - Street 1:275 W 12TH ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-1638
Practice Address - Country:US
Practice Address - Phone:765-472-8000
Practice Address - Fax:765-473-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-22
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
IN155315Medicare ID - Type Unspecified