Provider Demographics
NPI:1912959842
Name:BLUFFTON HEALTH SYSTEM LLC
Entity Type:Organization
Organization Name:BLUFFTON HEALTH SYSTEM LLC
Other - Org Name:BLUFFTON REGIONAL MEDICAL CENTER - SNF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:15679 COLLECTION CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60693-0156
Mailing Address - Country:US
Mailing Address - Phone:260-824-3500
Mailing Address - Fax:260-824-3704
Practice Address - Street 1:303 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2503
Practice Address - Country:US
Practice Address - Phone:260-919-5395
Practice Address - Fax:260-919-3173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUFFTON HEALTH SYSTEM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06005069-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
15-5373Medicare Oscar/Certification