Healthcare Provider Details

I. General information

NPI: 1902806490
Provider Name (Legal Business Name): CAMBRIDGE MANOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 TOWNSHIP LINE RD
INDIANAPOLIS IN
46260-1927
US

IV. Provider business mailing address

8530 TOWNSHIP LINE RD
INDIANAPOLIS IN
46260-1927
US

V. Phone/Fax

Practice location:
  • Phone: 317-876-9955
  • Fax: 317-876-6016
Mailing address:
  • Phone: 317-876-9955
  • Fax: 317-876-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4549
License Number StateIN

VIII. Authorized Official

Name: JOSEPH C TUTERA
Title or Position: PRESIDENT, CEO
Credential:
Phone: 816-444-0900