Provider Demographics
NPI:1437399888
Name:CROWNPOINTE COMMUNITIES LLC
Entity Type:Organization
Organization Name:CROWNPOINTE COMMUNITIES LLC
Other - Org Name:CROWNPOINTE OF INDIANAPOLIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-759-0230
Mailing Address - Street 1:1836 S. PATRIOT DR.
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47396-9000
Mailing Address - Country:US
Mailing Address - Phone:765-759-0230
Mailing Address - Fax:765-759-0240
Practice Address - Street 1:7365 E 16TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-2308
Practice Address - Country:US
Practice Address - Phone:317-351-2578
Practice Address - Fax:317-375-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN090057291310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200928160AMedicaid