BEVERLY HEALTHCARE, LLC (NPI# 1760439798) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760439798 |
| Entity Type | Organization |
| Organization Name | BEVERLY HEALTHCARE, LLC |
| Other Organization Name | BEVELRY LIVINGCENTER - FOUNTAINVIEW PLACE |
| Practice Address |
3175 Lancer St Portage IN 46368-4407 |
| Practice Telephone | 2197629571 |
| Mailing Telephone | 2197629571 |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2008-02-06 |
| Authorized Official Name | HOLLY A. JONES (SECRETARY) |
| Authorized Official Telephone | 4792014840 |
| Is Organization Subpart | Y |
| Parent Organization Name | BEVERLY ENTERPRISES - INDIANA, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | ANTHEM BCBS | 000000249228 | 01 |
| Other Name | Type Code |
|---|---|
| Bevelry LivingCenter - Fountainview Place | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396792198 | Beverly Healthcare, LLC | Skilled Nursing Facility | 1700 I St, Laporte, IN 46350-5750 | 2006-05-27 |
| 1548217359 | Beverly Healthcare, LLC | Skilled Nursing Facility | 1900 Andrew Ave, Laporte, IN 46350-6337 | 2006-05-27 |
| 1477500205 | Beverly Healthcare, LLC | Skilled Nursing Facility | 300 E Culver Rd, Knox, IN 46534-2058 | 2006-05-27 |
| 1467409292 | Beverly Healthcare, LLC | Skilled Nursing Facility | 1001 W Hively Ave, Elkhart, IN 46517-1742 | 2006-05-27 |
| 1780631838 | Beverly Healthcare, LLC | Skilled Nursing Facility | 2701 N Lyn Mar Dr, Muncie, IN 47304-5416 | 2006-05-27 |
| 1093762809 | Beverly Healthcare, LLC | Skilled Nursing Facility | 609 Tanglewood Ln, Mishawaka, IN 46545-2625 | 2006-05-27 |
| 1013963495 | Beverly Healthcare, LLC | Skilled Nursing Facility | 251 Sturdy Rd, Valparaiso, IN 46383-5921 | 2006-05-26 |
| 1699721167 | Beverly Healthcare, LLC | Skilled Nursing Facility | 8181 Harcourt Rd, Indianapolis, IN 46260-2578 | 2006-05-26 |
| 1366498727 | Beverly Healthcare, LLC | Skilled Nursing Facility | 2940 N Clinton St, Fort Wayne, IN 46805-1910 | 2006-05-26 |
| 1164478798 | Beverly Healthcare, LLC | Skilled Nursing Facility | 811 E 12th St, Mishawaka, IN 46544-5408 | 2006-05-25 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Indiana Business Entities | BEVERLY HEALTHCARE, LLC | 7160 N Dallas Parkway Suite 400, Plano, TX 75024 |
| Street Address |
3175 LANCER ST |
| City | PORTAGE |
| State | IN |
| Zip Code | 46368-4407 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568905461 | Dycora Transitional Health - Portage LLC | Skilled Nursing Facility | 3175 Lancer St, Portage, IN 46368-4407 | 2016-11-23 |
| 1275703092 | Hendricks County Hospital | Skilled Nursing Facility | 3175 Lancer St, Portage, IN 46368-4407 | 2008-03-07 |
| 1194807966 | Jeanine Elaine Davies | Nurse Practitioner | 3175 Lancer St, Portage, IN 46368-4407 | 2006-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366041121 | Latresa Renee Sims | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1777 Armstrong St. Suite C., Portage, IN 46368 | 2020-10-22 |
| 1831576693 | Bishara Robert Khoury | Family Medicine | 3545 Arbor Blvd Ste E, Portage, IN 46368 | 2015-04-30 |
| 1962813535 | Diane Farrington | Pharmacist | 6050 Us Hwy 6, Portage, IN 46368 | 2014-05-16 |
| 1588827562 | Jennifer Ann Rumpel | Allergy & Immunology | 6375 Us Highway 6 Ste C, Portage, IN 46368 | 2008-07-09 |
| 1588822688 | Total Renal Care Inc | Clinic/Center | 5823 Us Highway 6, Portage, IN 46368 | 2008-05-27 |
| 1235321480 | Michael Wendahl | Physical Therapist | 3691 Willowcreek Road, Suite 100, Portage, IN 46368 | 2007-08-13 |
| 1679663603 | Stephen V Headley | Family Medicine | 3283 Willowcreek Rd, Portage, IN 46368 | 2006-10-13 |
| 1730276486 | Robert Tan Ang | Psychiatry & Neurology | 3156 Willowcreek Road, Portage, IN 46368 | 2006-10-06 |
| 1013029883 | Primary Care PC | Family Medicine | 3125 Willowcreek Road, Portage, IN 46368 | 2006-08-31 |
| 1104936962 | Margaret Eileen Griffith | Dentist | 2646 Lois Street, Portage, IN 46368 | 2006-08-30 |
| Find all providers in zip 46368 | ||||
| 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 |
|---|---|---|---|---|
| 1669417473 | Tendercare Michigan Inc. | Skilled Nursing Facility | 7855 Currier Dr, Portage, MI 49002-4314 | 2006-06-17 |
| 1801886239 | Divine Savior Healthcare, Inc | Skilled Nursing Facility | 2805 Hunters Trail, Dba Aspirus Tivoli Community, Portage, WI 53901-0387 | 2005-10-26 |
| 1851397707 | Maple Winds Care Center Co. LLC | Skilled Nursing Facility | 4112 Springhill Road, Portage, PA 15946 | 2005-06-24 |
| 1346781820 | Maple Winds Healthcare and Rehabilitation Center, LLC | Skilled Nursing Facility | 4112 Springhill Rd, Portage, PA 15946-7402 | 2017-03-16 |
| 1568905461 | Dycora Transitional Health - Portage LLC | Skilled Nursing Facility | 3175 Lancer St, Portage, IN 46368-4407 | 2016-11-23 |
| 1427445865 | Thomas Sackett | Skilled Nursing Facility | 7855 Currier Dr, Portage, MI 49002-4314 | 2015-04-23 |
| 1497152565 | Portage Opco, LLC | Skilled Nursing Facility | 7855 Currier Dr, Portage, MI 49002-4314 | 2014-12-04 |
| 1275703092 | Hendricks County Hospital | Skilled Nursing Facility | 3175 Lancer St, Portage, IN 46368-4407 | 2008-03-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023618956 | Empowerme Rehabilitation Illinois, LLC | Skilled Nursing Facility | 3203 E Moores Pike, Bloomington, IN 47401-7122 | 2020-10-29 |
| 1629698808 | Decatur County Memorial Hospital | Skilled Nursing Facility | 6712 Restoracy Drive, Whitestown, IN 46075-0089 | 2020-04-17 |
| 1922586510 | Aperion Care Marion LLC | Skilled Nursing Facility | 614 W 14th St, Marion, IN 46953-2158 | 2018-08-06 |
| 1427548270 | Vibra Rehabilitation Hospital of Southern Indiana, LLC | Skilled Nursing Facility | 3104 Blackiston Boulevard, New Albany, IN 47150-9579 | 2018-05-17 |
| 1952812034 | Blue Diamond Villas | Skilled Nursing Facility | 1510 Sandpiper Lane, Goshen, IN 46526 | 2017-10-17 |
| 1366974404 | Mika Riddle | Skilled Nursing Facility | 407 W Walnut St, Van Buren, IN 46991 | 2017-03-29 |
| 1245787076 | Sara Steffe | Skilled Nursing Facility | 1015 Virginia St, Ferdinand, IN 47532-9285 | 2016-09-09 |
| 1770030504 | Valerie Burdette | Skilled Nursing Facility | 1872 E County Road 825 S, Oakland City, IN 47660-8911 | 2016-09-09 |
| 1205286507 | Christina Basham | Skilled Nursing Facility | 710 Bluffview Dr, Angola, IN 46703-2206 | 2016-06-16 |
| 1164878583 | Good Samaritan Hospital | Skilled Nursing Facility | 811 E. Baseline Road, Evansville, IN 47725-9340 | 2016-05-05 |
| Find all providers with the same taxonomy | ||||
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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.