Organization
EXTENDICARE HEALTH FACILITIES, INC.
Active
Other names
Michiana Health and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DONNA J MAASSEN (DIRECTOR OF COMPLIANCE)
(414) 908-8119
Entity
Organization
Contact information
Practice address
1420 E DOUGLAS ROAD, MISHAWAKA, IN 46545-1733
(502) 216-6344
Mailing address
111 W MICHIGAN ST, MILWAUKEE, WI 53203-2903
(414) 908-8119
(414) 908-7105
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201002500
—
IN
Enumeration date
05/11/2010
Last updated
04/28/2011
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