Provider Demographics
NPI:1982686242
Name:WOODLAWN HOSPITAL
Entity Type:Organization
Organization Name:WOODLAWN HOSPITAL
Other - Org Name:CATHERINE KASPER LIFE CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-224-1118
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:DONALDSON
Mailing Address - State:IN
Mailing Address - Zip Code:46513-0001
Mailing Address - Country:US
Mailing Address - Phone:574-935-1724
Mailing Address - Fax:574-935-1710
Practice Address - Street 1:9601 UNION RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563
Practice Address - Country:US
Practice Address - Phone:574-935-1724
Practice Address - Fax:574-935-1710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOODLAWN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-14
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN200382090A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200382090AMedicaid
IN155700Medicare Oscar/Certification