Provider Demographics
NPI:1548241045
Name:WOODLAWN HOSPITAL
Entity Type:Organization
Organization Name:WOODLAWN HOSPITAL
Other - Org Name:WESLEY MANOR HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-659-1811
Mailing Address - Street 1:1555 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IN
Mailing Address - Zip Code:46041-1167
Mailing Address - Country:US
Mailing Address - Phone:765-659-1811
Mailing Address - Fax:765-659-3216
Practice Address - Street 1:1555 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-1167
Practice Address - Country:US
Practice Address - Phone:765-659-1811
Practice Address - Fax:765-659-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN050011521313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200221050AMedicaid
IN200221050AMedicaid
155658Medicare ID - Type Unspecified