Provider Demographics
NPI:1720253313
Name:DAVIS ELDERLY CARE, LLC
Entity Type:Organization
Organization Name:DAVIS ELDERLY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-866-2532
Mailing Address - Street 1:5139 S HANOVER SALUDA RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:IN
Mailing Address - Zip Code:47243-9212
Mailing Address - Country:US
Mailing Address - Phone:812-866-2532
Mailing Address - Fax:812-866-2530
Practice Address - Street 1:5139 S HANOVER SALUDA RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:IN
Practice Address - Zip Code:47243-9212
Practice Address - Country:US
Practice Address - Phone:812-866-2532
Practice Address - Fax:812-866-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN200884710 C313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility