Provider Demographics
NPI:1659400554
Name:SOUTHWIND HEALTHCARE OF OWENSVILLE
Entity Type:Organization
Organization Name:SOUTHWIND HEALTHCARE OF OWENSVILLE
Other - Org Name:OWENSVILLE CONVALESCENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUDWYCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-729-7901
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:HWY. 165 WEST
Mailing Address - City:OWENSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47665-0369
Mailing Address - Country:US
Mailing Address - Phone:812-729-7901
Mailing Address - Fax:812-729-7446
Practice Address - Street 1:HWY. 165 WEST
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47665-0369
Practice Address - Country:US
Practice Address - Phone:812-729-7901
Practice Address - Fax:812-729-7446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
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
IN000000391859OtherANTHEM PIN #
IN000000391859OtherANTHEM PIN #