Provider Demographics
NPI:1376697201
Name:BETHANY VILLAGE INVENSTORS LLC
Entity Type:Organization
Organization Name:BETHANY VILLAGE INVENSTORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:HFA
Authorized Official - Phone:317-784-3066
Mailing Address - Street 1:3530 SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-3226
Mailing Address - Country:US
Mailing Address - Phone:317-784-3066
Mailing Address - Fax:317-781-3037
Practice Address - Street 1:3530 SHELBY ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-3226
Practice Address - Country:US
Practice Address - Phone:317-784-3066
Practice Address - Fax:317-781-3037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility