Provider Demographics
NPI:1487649190
Name:COMMUNITY VILLAGE, INC
Entity Type:Organization
Organization Name:COMMUNITY VILLAGE, INC
Other - Org Name:REHABILITATION CENTER AT HARTSFIELD VILLAGE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF POST ACUTE SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-934-0750
Mailing Address - Street 1:10000 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-934-0750
Mailing Address - Fax:219-934-2045
Practice Address - Street 1:503 OTIS BOWEN DRIVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-934-0590
Practice Address - Fax:219-934-2044
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY FOUNDATION OF NORTHWEST INDIANA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-19
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN050107581314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200229550Medicaid
IN050107581OtherCOMPRHENSIVE FACILITY LIC
IN155662Medicare Oscar/Certification