Provider Demographics
NPI:1851573075
Name:FAL-CORYDON, INC.
Entity Type:Organization
Organization Name:FAL-CORYDON, INC.
Other - Org Name:CORYDON NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:MANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-635-9500
Mailing Address - Street 1:315 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-1751
Mailing Address - Country:US
Mailing Address - Phone:812-738-2190
Mailing Address - Fax:812-738-3121
Practice Address - Street 1:315 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-1751
Practice Address - Country:US
Practice Address - Phone:812-738-2190
Practice Address - Fax:812-738-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
6159590001Medicare NSC
155441Medicare Oscar/Certification