Provider Demographics
NPI:1952416810
Name:HERITAGE HOUSE OF GREENSBURG
Entity Type:Organization
Organization Name:HERITAGE HOUSE OF GREENSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOUANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-663-7543
Mailing Address - Street 1:410 PARK RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-1953
Mailing Address - Country:US
Mailing Address - Phone:812-663-7543
Mailing Address - Fax:812-662-6800
Practice Address - Street 1:410 PARK RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1953
Practice Address - Country:US
Practice Address - Phone:812-663-7543
Practice Address - Fax:812-662-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060001171314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100266460Medicaid
IN100266460Medicaid