MEDICARE: LOCKEFIELD VILLAGE

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	314000000X	Skilled Nursing Facility		IN

General Provider Information

NPI Number	:	1275515082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOCKEFIELD VILLAGE

Provider Business Mailing Address
First Line	:	980 INDIANA AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2915
Country	:	US
Telephone Number	:	317-269-0448
Fax Number	:

Provider Business Practice Location Address
First Line	:	980 INDIANA AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2915
Country	:	US
Telephone Number	:	317-269-0448
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	DR. LIDA HARRIS
Credential	:
Telephone Number	:	317-639-6671

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	08/22/2020

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Directions to “LOCKEFIELD VILLAGE ” Practice Location

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