Provider Demographics
NPI:1225373343
Name:BROOKDALE SENIOR LIVING COMMUNITIES INC
Entity Type:Organization
Organization Name:BROOKDALE SENIOR LIVING COMMUNITIES INC
Other - Org Name:STERLING HOUSE OF KOKOMO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RIJOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-977-3700
Mailing Address - Street 1:3025 W SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-4176
Mailing Address - Country:US
Mailing Address - Phone:765-456-1490
Mailing Address - Fax:
Practice Address - Street 1:3025 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4176
Practice Address - Country:US
Practice Address - Phone:765-456-1490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE SENIOR LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12-011075-1310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
INAPPLIED FOROtherMEDICAID WAIVER