Basic Information
| Provider Information | |||||||||
| NPI: | 1326677576 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INDIANPOLISSENIORHOUSINGI OPCO, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27599 RIVERVIEW CENTER BLVD STE 201 | ||||||||
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| City: | BONITA SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341344327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396762346 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1251 W 96TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462601181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175759200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2020 | ||||||||
| LastUpdateDate: | 04/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | COSTELLO | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2399082925 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.