Provider Demographics
NPI:1326036047
Name:MIDDLETOWN HEALTHCARE MANAGEMENT INC
Entity Type:Organization
Organization Name:MIDDLETOWN HEALTHCARE MANAGEMENT INC
Other - Org Name:MIDDLETOWN NURSING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:SPAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:ADMIN/RN
Authorized Official - Phone:765-354-2223
Mailing Address - Street 1:131 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47356-9772
Mailing Address - Country:US
Mailing Address - Phone:765-354-2223
Mailing Address - Fax:765-354-9066
Practice Address - Street 1:131 S 10TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:IN
Practice Address - Zip Code:47356-9772
Practice Address - Country:US
Practice Address - Phone:765-354-2223
Practice Address - Fax:765-354-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN4712314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000098058OtherANTHEM
IN100289600AMedicaid
IN100289600AMedicaid
IN100289600AMedicaid