Provider Demographics
NPI:1578980561
Name:COMMUNITY DEVELOPMENT CORPORATION OF MISHAWAKA
Entity Type:Organization
Organization Name:COMMUNITY DEVELOPMENT CORPORATION OF MISHAWAKA
Other - Org Name:THE VANNONI LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-855-3937
Mailing Address - Street 1:500 LINCOLNWAY E
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2266
Mailing Address - Country:US
Mailing Address - Phone:574-855-3937
Mailing Address - Fax:574-855-3510
Practice Address - Street 1:500 LINCOLNWAY E
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2266
Practice Address - Country:US
Practice Address - Phone:574-855-3937
Practice Address - Fax:574-855-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12-012688-2310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility