Provider Demographics
NPI:1598852113
Name:MELLINGER HEALTH CARE INC
Entity Type:Organization
Organization Name:MELLINGER HEALTH CARE INC
Other - Org Name:LUANN NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-773-4119
Mailing Address - Street 1:952 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-1537
Mailing Address - Country:US
Mailing Address - Phone:574-773-4119
Mailing Address - Fax:574-773-2371
Practice Address - Street 1:952 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-1537
Practice Address - Country:US
Practice Address - Phone:574-773-4119
Practice Address - Fax:574-773-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06-000317-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100274860AMedicaid
IN155722Medicare Oscar/Certification