Provider Demographics
NPI:1528025236
Name:LITTLE SISTERS OF THE POOR OF INDIANAPOLIS INC.
Entity Type:Organization
Organization Name:LITTLE SISTERS OF THE POOR OF INDIANAPOLIS INC.
Other - Org Name:ST. AUGUSTINE HOME FOR THE AGED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-503-2206
Mailing Address - Street 1:2345 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1905
Mailing Address - Country:US
Mailing Address - Phone:317-415-5767
Mailing Address - Fax:317-415-5773
Practice Address - Street 1:2345 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1905
Practice Address - Country:US
Practice Address - Phone:317-415-5767
Practice Address - Fax:317-415-5773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-000389-1310400000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100288920AMedicaid