Provider Demographics
NPI:1134217201
Name:SPRINGFIELD HEALTH CARE CENTER, INC
Entity type:Organization
Organization Name:SPRINGFIELD HEALTH CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TORON
Authorized Official - Middle Name:U
Authorized Official - Last Name:JACKSON-KENNY
Authorized Official - Suffix:
Authorized Official - Credentials:HFA
Authorized Official - Phone:317-253-3486
Mailing Address - Street 1:6130 MICHIGAN RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-1200
Mailing Address - Country:US
Mailing Address - Phone:317-253-3496
Mailing Address - Fax:
Practice Address - Street 1:6130 MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-1200
Practice Address - Country:US
Practice Address - Phone:317-253-3496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06000394314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100273900AMedicaid
IN100273900AMedicaid