Provider Demographics
NPI:1457387060
Name:HOOSIER CARE III, INC.
Entity type:Organization
Organization Name:HOOSIER CARE III, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-378-9027
Mailing Address - Street 1:3200 SYCAMORE CT
Mailing Address - Street 2:SUITE 113
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1545
Mailing Address - Country:US
Mailing Address - Phone:812-378-9027
Mailing Address - Fax:
Practice Address - Street 1:3200 SYCAMORE CT
Practice Address - Street 2:SUITE 113
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-1545
Practice Address - Country:US
Practice Address - Phone:812-378-9027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1031314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
11100OtherELDER HEALTH
DE0000321812Medicaid
0117439OtherAETNA-HMO
PN5OtherCAREFIRST IND/PPO
021IOtherCAREFIRST - PROV/INQ#
0004639000OtherIBC
DE000321711Medicaid
0004639000OtherAMERIHEALTH
PN5OtherCAREFIRST - BLUE CHOICE
245082OtherUNITED MAMSI
71-01244OtherUNITED - EVERCARE
155031OtherBC/BS OF DELAWARE
0004639000OtherIBC
155031OtherBC/BS OF DELAWARE
PN5OtherCAREFIRST IND/PPO
PN5OtherCAREFIRST - BLUE CHOICE
11100OtherELDER HEALTH
245082OtherUNITED MAMSI