# EXTENDICARE HEALTH SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083002521
- **Authorized official:** MR. MICHAEL MATTHEWS (PTA)
- **Authorized official phone:** (812) 739-2292

## Contact information

- **Practice address:** 712 W 2ND ST, LEAVENWORTH, IN 47137-2264
- **Practice address phone:** (812) 739-2292
- **Mailing address:** 712 W 2ND ST, LEAVENWORTH, IN 47137-2264

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 06004780A | IN | Yes |

## Other

- **Enumeration date:** 01/07/2015
- **Last updated:** 01/07/2015