Provider Demographics
NPI:1720195597
Name:HOOSIER VILLAGE RETIREMENT CENTER
Entity Type:Organization
Organization Name:HOOSIER VILLAGE RETIREMENT CENTER
Other - Org Name:HOOSIER VILLAGE RETIREMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-873-3371
Mailing Address - Street 1:9875 CHERRYLEAF DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3940
Mailing Address - Country:US
Mailing Address - Phone:317-873-3371
Mailing Address - Fax:317-873-4856
Practice Address - Street 1:9875 CHERRYLEAF DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3940
Practice Address - Country:US
Practice Address - Phone:317-873-3371
Practice Address - Fax:317-873-4856
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BHI SENIOR LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-25
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-1000548-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15-5472Medicare PIN