ADAMS COUNTY MEMORIAL HOSPITAL (NPI# 1073554200) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073554200 |
| Entity Type | Organization |
| Organization Name | ADAMS COUNTY MEMORIAL HOSPITAL |
| Other Organization Name | LUTHERAN LIFE VILLAGES (ANTHONY) |
| Practice Address |
6701 South Anthony Boulevard Fort Wayne IN 46816-2035 |
| Mailing Address |
1100 Mercer Ave Decatur IN 46733-2303 |
| Practice Telephone | 2604470800 |
| Practice Fax Number | 2604477369 |
| Mailing Telephone | 2607242145 |
| Mailing Fax Number | 2607283852 |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2014-09-29 |
| Authorized Official Name | MR. DANE WHEELER (CFO/TREASURER) |
| Authorized Official Telephone | 2607242145 |
| Authorized Official Credential | CPA |
| Is Organization Subpart | Y |
| Parent Organization Name | ADAMS COUNTY MEMORIAL HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 313M00000X | Nursing Facility/Intermediate Care Facility | 050002831 | IN | Nursing & Custodial Care Facilities |
| N | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities | ||
| Y | 314000000X | Skilled Nursing Facility | 050002831 | IN | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 201235720A | 05 | |
| RCAP | 0220 | 01 | |
| IN | 100275020 | 05 |
| Other Name | Type Code |
|---|---|
| Lutheran Life Villages (Anthony) | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891031480 | Adams County Memorial Hospital | Skilled Nursing Facility | 1350 West Main Street, Berne, IN 46711-1794 | 2012-12-31 |
| 1134493281 | Adams County Memorial Hospital | Nursing Facility/Intermediate Care Facility | 9802 Coldwater Road, Fort Wayne, IN 46825 | 2012-03-06 |
| 1982729604 | Adams County Memorial Hospital | Nursing Facility/Intermediate Care Facility | 6996 S Us 421, Versailles, IN 47042-9390 | 2007-03-20 |
| 1760519268 | Adams County Memorial Hospital | Skilled Nursing Facility | 12011 Whittern Rd, Monroeville, IN 46773-9126 | 2007-02-28 |
| 1356476154 | Adams County Memorial Hospital | Skilled Nursing Facility | 1300 Mercer Ave, Decatur, IN 46733-2407 | 2007-02-22 |
| 1477699460 | Adams County Memorial Hospital | Skilled Nursing Facility | 200 West Fourth Dtreet, Oaktown, IN 47561-8081 | 2007-01-29 |
| 1235205816 | Adams County Memorial Hospital | Skilled Nursing Facility | 520 W 9th Street, Jasper, IN 47546-2711 | 2006-11-27 |
| 1659454148 | Adams County Memorial Hospital | Skilled Nursing Facility | 9325 N. Crawford Streeet, Knightsville, IN 47857-0170 | 2006-10-20 |
| 1366531907 | Adams County Memorial Hospital | Assisted Living Facility | 400 Caylor Boulevard, Bluffton, IN 46714-8805 | 2006-10-12 |
| 1821185356 | Adams County Memorial Hospital | Skilled Nursing Facility | 17475 Dugdale Dr, South Bend, IN 46635-1545 | 2006-10-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ADAMS COUNTY MEMORIAL HOSPITAL | 1100 Mercer Ave, Decatur, IN 46733-2303 |
| Street Address |
6701 SOUTH ANTHONY BOULEVARD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46816-2035 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841769270 | Brian Bernard Conaway | Occupational Therapist | 7125 S Hanna St, Fort Wayne, IN 46816 | 2018-11-14 |
| 1073006938 | Fort Wayne Aal Lp | Assisted Living Facility | 7125 S Hanna Street, Fort Wayne, IN 46816 | 2018-06-14 |
| 1811282064 | Connisha Sanders | Occupational Therapy Assistant | 8309, Bridgeway Cir Apt 3a, Fort Wayne, IN 46816 | 2011-06-16 |
| 1144239609 | James J Bohlin | Dentist | 7524 South Anthony Blvd., Fort Wayne, IN 46816 | 2006-08-05 |
| 1578594537 | K Mart Corp | Pharmacy | 7530 S Anthony Blvd, Fort Wayne, IN 46816 | 2006-07-06 |
| 1720540503 | Jill Ann Woodward | Occupational Therapy Assistant | 7125 S Hanna St, Fort Wayne, IN 46816 | 2019-04-02 |
| 1639163884 | Patrice C Ellingson | Optometrist | 1515 E Paulding Rd, Fort Wayne, IN 46816 | 2005-09-02 |
| 1114140134 | Jon D. Ingleman | Dentist | 223 E Tillman Rd, Fort Wayne, IN 46816-1016 | 2007-04-10 |
| 1538189063 | Yoder/rahrig Family Dentistry | Dentist | 333 E Tillman Rd, Fort Wayne, IN 46816-1017 | 2006-07-20 |
| 1619997137 | Gerald J. Rahrig | Dentist | 333 E Tillman Rd, Fort Wayne, IN 46816-1017 | 2006-07-20 |
| Find all providers in zip 46816 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023487592 | Lindsey Marie Fuller | Skilled Nursing Facility | 10603 Wild Flower Pl, Fort Wayne, IN 46845-1687 | 2015-09-15 |
| 1336548353 | Pulaski Memorial Hospital | Skilled Nursing Facility | 6050 S Cr 800 E-92, Fort Wayne, IN 46814-9201 | 2014-08-14 |
| 1154766459 | Major Hospital | Skilled Nursing Facility | 10445 Dupont Oaks Blvd, Fort Wayne, IN 46845-8792 | 2013-05-01 |
| 1326310400 | Riverview Hospital | Skilled Nursing Facility | 4111 Park Place Drive, Fort Wayne, IN 46845-8793 | 2012-02-03 |
| 1710280888 | Kelly Michelle Wood | Skilled Nursing Facility | 8528 Killeen Run, Fort Wayne, IN 46835-9657 | 2010-12-13 |
| 1194940205 | Recovery Health Services, Inc | Skilled Nursing Facility | 12101 Lima Rd, Fort Wayne, IN 46818-8903 | 2007-04-16 |
| 1871623041 | Henry County Memorial Hospital | Skilled Nursing Facility | 1400 Medical Park Dr, Fort Wayne, IN 46825-5832 | 2007-03-06 |
| 1740315878 | Henry County Memorial Hospital | Skilled Nursing Facility | 5700 Wilkie Dr, Fort Wayne, IN 46804-1662 | 2007-02-22 |
| 1326180803 | Woodlawn Hospital | Skilled Nursing Facility | 3136 Goeglein Rd, Fort Wayne, IN 46815-6685 | 2007-02-13 |
| 1528130432 | Indiana Health & Rehabilitation Center | Skilled Nursing Facility | 3811 Parnell Ave, Fort Wayne, IN 46805-1409 | 2006-11-15 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46816 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.