Provider Demographics
NPI:1578628327
Name:HOOSIER ENTERPRISES V, INC.
Entity Type:Organization
Organization Name:HOOSIER ENTERPRISES V, INC.
Other - Org Name:WILLOW CROSSING HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-818-1240
Mailing Address - Street 1:9455 DELEGATES ROW
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3805
Mailing Address - Country:US
Mailing Address - Phone:317-818-1240
Mailing Address - Fax:317-818-1240
Practice Address - Street 1:3550 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2035
Practice Address - Country:US
Practice Address - Phone:812-379-9669
Practice Address - Fax:812-378-5248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
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
IN155535Medicare ID - Type Unspecified