Provider Demographics
NPI:1417710138
Name:GROVE CITY SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:GROVE CITY SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-669-8404
Mailing Address - Street 1:911 E 86TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1840
Mailing Address - Country:US
Mailing Address - Phone:317-669-8404
Mailing Address - Fax:
Practice Address - Street 1:3615 GLACIAL LN
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3739
Practice Address - Country:US
Practice Address - Phone:614-957-0029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility