Organization
DYCORA TRANSITIONAL HEALTH - PORTAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY HAWKINS (EXECUTIVE)
(219) 762-9571
Entity
Organization
Contact information
Practice address
3175 LANCER ST, PORTAGE, IN 46368-4407
(219) 762-9571
Mailing address
3175 LANCER ST, PORTAGE, IN 46368-4407
(219) 762-9571
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
IN
Other
Enumeration date
11/23/2016
Last updated
01/24/2018
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