Provider Demographics
NPI:1245289826
Name:CCRC OPCO - ROBIN RUN, LLC
Entity type:Organization
Organization Name:CCRC OPCO - ROBIN RUN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:OHLENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-918-5000
Mailing Address - Street 1:6370 ROBIN RUN W
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-4051
Mailing Address - Country:US
Mailing Address - Phone:371-293-5500
Mailing Address - Fax:317-298-2899
Practice Address - Street 1:6370 ROBIN RUN W
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-4051
Practice Address - Country:US
Practice Address - Phone:371-293-5500
Practice Address - Fax:317-298-2899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE LIVING COMMUNITIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-09
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-001156-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100453350BMedicaid
IN155505Medicare Oscar/Certification