Provider Demographics
NPI:1164599304
Name:DECATUR COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DECATUR COUNTY MEMORIAL HOSPITAL
Other - Org Name:MORNINGSIDE NURSING AND MEMORY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-663-1170
Mailing Address - Street 1:8833 GROSS POINT RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1859
Mailing Address - Country:US
Mailing Address - Phone:847-679-6200
Mailing Address - Fax:847-679-6236
Practice Address - Street 1:18325 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637
Practice Address - Country:US
Practice Address - Phone:574-272-2602
Practice Address - Fax:574-272-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN14003759311500000X
IN11-004732-1311500000X
IN15-0047321-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200808300AMedicaid
IN155752Medicare Oscar/Certification