Provider Demographics
NPI:1659452449
Name:AMERICARE LIVING CENTERS III, LLC
Entity Type:Organization
Organization Name:AMERICARE LIVING CENTERS III, LLC
Other - Org Name:TRINITY VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE A/R MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDEFUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-282-2889
Mailing Address - Street 1:421 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47305-2459
Mailing Address - Country:US
Mailing Address - Phone:765-282-2889
Mailing Address - Fax:765-281-5530
Practice Address - Street 1:4301 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0678
Practice Address - Country:US
Practice Address - Phone:812-477-8971
Practice Address - Fax:812-471-3258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
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
IN155749Medicare ID - Type Unspecified