Healthcare Provider Details

I. General information

NPI: 1427058288
Provider Name (Legal Business Name): SWISS VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 W MAIN ST
BERNE IN
46711-1741
US

IV. Provider business mailing address

1350 W MAIN ST
BERNE IN
46711-1741
US

V. Phone/Fax

Practice location:
  • Phone: 260-589-3173
  • Fax: 260-589-8369
Mailing address:
  • Phone: 260-589-3173
  • Fax: 260-589-8369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number120002801
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number120002801
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number120002801
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number120002801
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number120002801
License Number StateIN

VIII. Authorized Official

Name: ROGER D YOUNG
Title or Position: CONTROLLER
Credential:
Phone: 260-589-3173