Provider Demographics
NPI:1053619841
Name:STRATFORD RETIREMENT, LLC
Entity type:Organization
Organization Name:STRATFORD RETIREMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-246-1611
Mailing Address - Street 1:2460 GLEBE ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7154
Mailing Address - Country:US
Mailing Address - Phone:317-733-9650
Mailing Address - Fax:317-733-9651
Practice Address - Street 1:2460 GLEBE ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7154
Practice Address - Country:US
Practice Address - Phone:317-733-9650
Practice Address - Fax:317-733-9651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIOR LIVING COMMUNITIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-03
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10-011151-1310400000X, 311500000X
IN314000000X
IN14-011151-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
155794Medicare Oscar/Certification