Provider Demographics
NPI:1396201521
Name:INDIANA SENIOR HOUSING HEALTH CARE PROPERTIES, INC.
Entity Type:Organization
Organization Name:INDIANA SENIOR HOUSING HEALTH CARE PROPERTIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHARIMAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITLATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-332-9295
Mailing Address - Street 1:5467 CEDAR VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8693
Mailing Address - Country:US
Mailing Address - Phone:513-754-3100
Mailing Address - Fax:513-336-3174
Practice Address - Street 1:5467 CEDAR VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8693
Practice Address - Country:US
Practice Address - Phone:513-754-3100
Practice Address - Fax:513-336-3174
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANA SENIOR HOUSING HEALTH CARE PROPERTIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0320846Medicaid