Provider Demographics
NPI:1255441663
Name:BHI SENIOR LIVING, INC.
Entity type:Organization
Organization Name:BHI SENIOR LIVING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:5415 BEARBERRY LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3922
Mailing Address - Country:US
Mailing Address - Phone:317-873-3371
Mailing Address - Fax:317-873-4856
Practice Address - Street 1:2209 SAINT JOE CENTER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5061
Practice Address - Country:US
Practice Address - Phone:260-483-3116
Practice Address - Fax:260-873-9156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-000541-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15-5475Medicare PIN