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Organization
DAVIESS COUNTY HOSPITAL
Active
Organization
DAVIESS COUNTY HOSPITAL
Active
Other names
Diversicare of Providence, Charlestown Place at New Albany
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA CAMPBELL (DELEGATED OFFICIAL)
(859) 255-0075
Entity
Organization
Contact information
Practice address
4915 CHARLESTOWN RD, NEW ALBANY, IN 47150-9426
(812) 945-5221
(812) 945-2614
Mailing address
1050 CHINOE RD STE 350, LEXINGTON, KY 40502-6571
(859) 255-0075
(859) 281-5150
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
16-001144-1
IN
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841625662
UNITED HEALTHCARE
—
05
—
200256980
—
IN
Enumeration date
09/11/2013
Last updated
01/12/2024
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