Provider Demographics
NPI:1427368505
Name:RITTENHOUSE SENIOR LIVING OF PORTAGE LLC
Entity Type:Organization
Organization Name:RITTENHOUSE SENIOR LIVING OF PORTAGE LLC
Other - Org Name:RSL OF PORTAGE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:HFA
Authorized Official - Phone:219-764-2900
Mailing Address - Street 1:6235 STERLING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-7715
Mailing Address - Country:US
Mailing Address - Phone:219-764-2900
Mailing Address - Fax:219-764-0900
Practice Address - Street 1:6235 STERLING CREEK RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-7715
Practice Address - Country:US
Practice Address - Phone:219-764-2900
Practice Address - Fax:219-764-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN121396310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility