Provider Demographics
NPI:1760425391
Name:HOLY CROSS VILLAGE AT NOTRE DAME, INC.
Entity Type:Organization
Organization Name:HOLY CROSS VILLAGE AT NOTRE DAME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-287-1838
Mailing Address - Street 1:54515 STATE ROAD 933
Mailing Address - Street 2:P.O. BOX 706
Mailing Address - City:NOTRE DAME
Mailing Address - State:IN
Mailing Address - Zip Code:46556
Mailing Address - Country:US
Mailing Address - Phone:574-287-1838
Mailing Address - Fax:574-289-7277
Practice Address - Street 1:54515 STATE ROAD 933
Practice Address - Street 2:
Practice Address - City:NOTRE DAME
Practice Address - State:IN
Practice Address - Zip Code:46556
Practice Address - Country:US
Practice Address - Phone:574-287-1838
Practice Address - Fax:574-289-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-002668-2314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200325990Medicaid
IN200325990Medicaid