Provider Demographics
NPI:1255404984
Name:LEE ALAN BRYANT HEALTH CARE FACILITIES
Entity type:Organization
Organization Name:LEE ALAN BRYANT HEALTH CARE FACILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ELMER
Authorized Official - Last Name:NICKLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:765-569-6654
Mailing Address - Street 1:3838 E OLD 36 RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47872-7710
Mailing Address - Country:US
Mailing Address - Phone:765-569-6654
Mailing Address - Fax:765-569-0551
Practice Address - Street 1:3838 E OLD 36 RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872-7710
Practice Address - Country:US
Practice Address - Phone:765-569-6654
Practice Address - Fax:765-569-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15-5646Medicare ID - Type Unspecified