Healthcare Provider Details

I. General information

NPI: 1053459719
Provider Name (Legal Business Name): FALL CREEK RETIREMENT VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

625 E WATER ST
PENDLETON IN
46064-8551
US

IV. Provider business mailing address

625 E WATER ST
PENDLETON IN
46064-8551
US

V. Phone/Fax

Practice location:
  • Phone: 765-778-2384
  • Fax:
Mailing address:
  • Phone: 765-778-2384
  • 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: CORPORATE BOOKKEEPER
Credential:
Phone: 765-649-4558