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General NPI Number Information
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NPI Number | 1225196595
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Entity Type | Organization
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Legal Business Name | CAPITAL SENIOR LIVING ILM-B INC.
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7250 ARTHUR BLVD
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City | MERRILLVILLE
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State | IN
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Zip | 46410-3766
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Country | US
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Telephone | 219-736-2900
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Fax | 219-736-2209
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Provider Business Mailing Address
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Address Line | 7250 ARTHUR BLVD
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City | MERRILLVILLE
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State | IN
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Zip | 46410-3766
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Country | US
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Telephone | 219-736-2900
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Fax | 219-736-2209
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MICHAEL DAVID MOORE
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Credential | M.H.A. - H.C.F.A.
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Telephone | 219-736-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State | IN
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