Provider Demographics
NPI:1013133776
Name:DAVIESS COUNTY HOSPITAL
Entity Type:Organization
Organization Name:DAVIESS COUNTY HOSPITAL
Other - Org Name:CAPITOL VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:DERON
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-254-2760
Mailing Address - Street 1:1314 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-2860
Mailing Address - Country:US
Mailing Address - Phone:812-254-2760
Mailing Address - Fax:260-728-3852
Practice Address - Street 1:2926 N. CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-0356
Practice Address - Country:US
Practice Address - Phone:317-926-0254
Practice Address - Fax:317-926-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07-000567-1314000000X
IN14-000567-2314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100298560Medicaid
IN155711Medicare Oscar/Certification