| NPI | 1114986924 |
|---|---|
| Doing Business As | PROVIDENCE HEALTH CARE CENTER |
| Entity Type | Organization |
| Authorized Contact | DENNIS WEATHERFORD President & CEO 765-655-2620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2014-11-20 |