Provider Demographics
NPI:1053459719
Name:FALL CREEK RETIREMENT VILLAGE, INC.
Entity Type:Organization
Organization Name:FALL CREEK RETIREMENT VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:JAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-649-4558
Mailing Address - Street 1:625 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-8551
Mailing Address - Country:US
Mailing Address - Phone:765-778-2384
Mailing Address - Fax:
Practice Address - Street 1:625 E WATER ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-8551
Practice Address - Country:US
Practice Address - Phone:765-778-2384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility