Healthcare Provider Details

I. General information

NPI: 1730384009
Provider Name (Legal Business Name): HP PLEASANT RUN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7465 MADISON AVE
INDIANAPOLIS IN
46227-6564
US

IV. Provider business mailing address

7465 SOUTH MADISON AVENUE
INDIANAPOLIS IN
46227
US

V. Phone/Fax

Practice location:
  • Phone: 317-787-1108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateIN

VIII. Authorized Official

Name: DOUGLAS K MITTLEIDER
Title or Position: PRESIDENT
Credential:
Phone: 770-619-0866