Organization
WOODLAWN HOSPITAL
Active
Other names
Grace Village Health Care Facility
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN ALLEY (PRESIDENT/CEO)
(574) 223-3141
Entity
Organization
Contact information
Practice address
337 GRACE VILLAGE DR, WINONA LAKE, IN 46590-5774
(574) 372-6200
(574) 372-6386
Mailing address
337 GRACE VILLAGE DR, WINONA LAKE, IN 46590-5774
(574) 372-6200
(574) 372-6386
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
060005011
IN
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
060005011
IN
314000000X
Skilled Nursing Facility
060005011
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000097895
ANTHEM PIN NUMBER
IN
05
—
100266260A
—
IN
01
—
2297
RBA HOME NUMBER
IN
Enumeration date
10/12/2006
Last updated
11/25/2013
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