Healthcare Provider Details

I. General information

NPI: 1275781866
Provider Name (Legal Business Name): UNIVERSITY HEIGHTS HEALTH & LIVING COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E COUNTY LINE RD
INDIANAPOLIS IN
46227-0962
US

IV. Provider business mailing address

1380 E COUNTY LINE RD
INDIANAPOLIS IN
46227-0962
US

V. Phone/Fax

Practice location:
  • Phone: 317-888-3581
  • Fax: 317-885-1022
Mailing address:
  • Phone: 317-888-3581
  • Fax: 317-885-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05002711A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number05002711A
License Number StateIN

VIII. Authorized Official

Name: MR. STEPHEN MOORE
Title or Position: OWNER/CEO
Credential: M.D.
Phone: 812-332-2265