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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