| NPI | 1992792303 |
|---|---|
| Doing Business As | PROVIDENCE RETIREMENT HOME |
| Entity Type | Organization |
| Authorized Contact | WILLIAM ROBERT LEE CFO 812-945-5221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: IN 05-001144-1) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2020-08-22 |