Provider Demographics
NPI:1891117784
Name:CAPITAL SENIOR LIVING PROPERTIES 4, INC.
Entity Type:Organization
Organization Name:CAPITAL SENIOR LIVING PROPERTIES 4, INC.
Other - Org Name:CSL CHARLESTOWN, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-770-5600
Mailing Address - Street 1:2400 MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111
Mailing Address - Country:US
Mailing Address - Phone:812-406-1099
Mailing Address - Fax:812-406-1101
Practice Address - Street 1:2400 MARKET STREET
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111
Practice Address - Country:US
Practice Address - Phone:812-406-1099
Practice Address - Fax:812-406-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13-012007-1310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility