Provider Demographics
NPI:1679878722
Name:THE HOOSIER CHRISTIAN VILLAGE
Entity Type:Organization
Organization Name:THE HOOSIER CHRISTIAN VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FIANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-587-7903
Mailing Address - Street 1:621 S SUGAR ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47220-2066
Mailing Address - Country:US
Mailing Address - Phone:812-358-2504
Mailing Address - Fax:812-358-2510
Practice Address - Street 1:621 S SUGAR ST
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47220-2066
Practice Address - Country:US
Practice Address - Phone:812-358-2504
Practice Address - Fax:812-358-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06-000277-1261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100290530Medicaid
IN100290530Medicaid