Healthcare Provider Details

I. General information

NPI: 1922140755
Provider Name (Legal Business Name): THE LODGE AT THE HARBOURS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 SHERIDAN RD
NOBLESVILLE IN
46062-8723
US

IV. Provider business mailing address

1667 SHERIDAN RD
NOBLESVILLE IN
46062-8723
US

V. Phone/Fax

Practice location:
  • Phone: 317-770-3400
  • Fax:
Mailing address:
  • Phone: 317-770-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JAYNA FRIEND
Title or Position: BOOKKEEPER
Credential:
Phone: 765-649-4558