Provider Demographics
NPI:1912072596
Name:RESIDENTIAL CARE II, LLC
Entity Type:Organization
Organization Name:RESIDENTIAL CARE II, LLC
Other - Org Name:FOREST CREEK COMMONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:BURKHART
Authorized Official - Suffix:II
Authorized Official - Credentials:CPA
Authorized Official - Phone:317-788-2500
Mailing Address - Street 1:6510 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2288
Mailing Address - Country:US
Mailing Address - Phone:317-783-4663
Mailing Address - Fax:317-783-4647
Practice Address - Street 1:6510 S EAST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2288
Practice Address - Country:US
Practice Address - Phone:317-783-4663
Practice Address - Fax:317-783-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility