Provider Demographics
NPI:1114308616
Name:HUGO SENIOR HOUSING, LLC
Entity Type:Organization
Organization Name:HUGO SENIOR HOUSING, LLC
Other - Org Name:KEYSTONE PLACE AT LAVALLE FIELDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-280-8455
Mailing Address - Street 1:3965 AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5845
Mailing Address - Country:US
Mailing Address - Phone:317-280-8455
Mailing Address - Fax:317-875-4051
Practice Address - Street 1:3965 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5845
Practice Address - Country:US
Practice Address - Phone:317-280-8455
Practice Address - Fax:317-875-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility