Provider Demographics
NPI:1780995860
Name:RSL VALPARAISO
Entity type:Organization
Organization Name:RSL VALPARAISO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEFLERS
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:219-531-2484
Mailing Address - Street 1:1300 VALE PARK RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2722
Mailing Address - Country:US
Mailing Address - Phone:219-531-2484
Mailing Address - Fax:219-531-2485
Practice Address - Street 1:1300 VALE PARK RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2722
Practice Address - Country:US
Practice Address - Phone:219-531-2484
Practice Address - Fax:219-531-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10-012181-1310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility