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General NPI Number Information
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NPI Number | 1053459719
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Entity Type | Organization
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Legal Business Name | FALL CREEK RETIREMENT VILLAGE, INC.
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 625 E WATER ST
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City | PENDLETON
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State | IN
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Zip | 46064-8551
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Country | US
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Telephone | 765-778-2384
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Fax |
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Provider Business Mailing Address
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Address Line | 625 E WATER ST
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City | PENDLETON
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State | IN
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Zip | 46064-8551
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Country | US
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Telephone | 765-778-2384
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Fax |
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Authorized Official
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Title or Position | CORPORATE BOOKKEEPER
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Name | JAYNA FRIEND
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Credential |
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Telephone | 765-649-4558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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