MEDICARE: CHRISTOLE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility	2510B0009JN07	IN

General Provider Information

NPI Number	:	1104910983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTOLE, INC

Provider Business Mailing Address
First Line	:	200 HAWTHORNE
Second Line	:
City	:	NASHVILLE
State	:	IN
Zip	:	47448
Country	:	US
Telephone Number	:	812-988-1257
Fax Number	:	812-988-1736

Provider Business Practice Location Address
First Line	:	1922 LIMESTONE DRIVE
Second Line	:
City	:	ELLETTSVILLE
State	:	IN
Zip	:	47429
Country	:	US
Telephone Number	:	812-876-8721
Fax Number	:	812-876-0715

Authorized Official
Title or Position	:	CEO
Name	:	MR. ROBERT B. CLEMONS
Credential	:
Telephone Number	:	812-988-1257

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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Directions to “CHRISTOLE, INC ” Practice Location

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