Provider Demographics
NPI:1427036482
Name:MULBERRY HEALTH & RETIREMENT COMMUNITY, INC.
Entity Type:Organization
Organization Name:MULBERRY HEALTH & RETIREMENT COMMUNITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFSCHLAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-296-2911
Mailing Address - Street 1:502 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:IN
Mailing Address - Zip Code:46058-9538
Mailing Address - Country:US
Mailing Address - Phone:765-296-2911
Mailing Address - Fax:765-296-9116
Practice Address - Street 1:502 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:IN
Practice Address - Zip Code:46058-9538
Practice Address - Country:US
Practice Address - Phone:765-296-2911
Practice Address - Fax:765-296-9116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN155600Medicare ID - Type Unspecified