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Organization
MAJOR HOSPITAL
Active
Organization
MAJOR HOSPITAL
Active
Other names
The Waters of Dillsboro-Ross Manor
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HORNER (PRESIDENT & CEO)
(317) 398-5255
Entity
Organization
Contact information
Practice address
12803 LENOVER ST, DILLSBORO, IN 47018-9418
(812) 432-5226
(812) 432-3311
Mailing address
240 FENCL LANE, HILLSIDE, IL 60162-2067
(708) 449-1900
(708) 449-1500
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
05-000178-1
IN
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000383032
ANTHEM BCBS
IN
01
—
000000385603
ANTHEM BCBS PT OUTPATIENT
IN
01
—
000000385604
ANTHEM BCBS OT OUTPATIENT
IN
01
—
000000385605
ANTHEM BCBS ST OUTPATIENT
IN
05
—
100273840C
—
IN
Enumeration date
06/08/2006
Last updated
08/07/2014
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