Basic Information
| Provider Information | |||||||||
| NPI: | 1891940979 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RITTENHOUSE SENIOR LIVING, LLC | ||||||||
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| OtherOrganizationName: | RITTENHOUSE SENIOR LIVING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1251 W 96TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462601181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175759200 | ||||||||
| FaxNumber: | 3175758209 | ||||||||
| Practice Location | |||||||||
| Address1: | 1251 W 96TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462601181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175759200 | ||||||||
| FaxNumber: | 3175758209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2008 | ||||||||
| LastUpdateDate: | 11/17/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FRANK | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3175759200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 08-003282-2 | IN | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 200908970A | 05 | IN | MEDICAID |