Provider Demographics
NPI:1326582701
Name:HOOSIER CARE INC.
Entity Type:Organization
Organization Name:HOOSIER CARE INC.
Other - Org Name:SWANN SPECIAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CBO AR SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:WYNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:EAKLE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:815-625-5820
Mailing Address - Street 1:1050 CHINOE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-6571
Mailing Address - Country:US
Mailing Address - Phone:859-255-0075
Mailing Address - Fax:859-281-5150
Practice Address - Street 1:109 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-2905
Practice Address - Country:US
Practice Address - Phone:217-356-5164
Practice Address - Fax:217-356-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0035485251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-001Medicaid