MLB Meridian Health Facilities, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

MLB MERIDIAN HEALTH FACILITIES, INC

Practice address

2102 S Meridian St
Indianapolis, IN 46225-1923

Phone

(317) 786-9426

Fax

(317) 786-9428

NPI assigned

Jun 20, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

William Mando

Title

Cfo

Phone

(813) 635-9500

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Meridian Nursing and Rehab Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902801574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2102 S MERIDIAN ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462251923",
            "telephone_number": "317-786-9426",
            "fax_number": "317-786-9428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2102 S MERIDIAN ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462251923",
            "telephone_number": "317-786-9426",
            "fax_number": "317-786-9428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MLB MERIDIAN HEALTH FACILITIES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MANDO",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "813-635-9500"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10028620D",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meridian Nursing and Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Satoshi Miyahara
• Alexandra Miyamoto
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• Richard T Miyamoto, M.D.
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• Candice Diane Moad, NP
• Mohannad Moallem, M.D.

• Skilled Nursing Facility in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Skilled Nursing Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.