=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467343319
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMONS AT JUDAY CREEK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2025
-----------------------------------------------------
Last Update Date | 07/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17441 STATE ROUTE 23
-----------------------------------------------------
City | SOUTH BEND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-273-2233
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5904 E STATE BLVD
-----------------------------------------------------
City | FORT WAYNE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46815-7637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-740-3220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SHERRI BERGHOFF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 260-740-3220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------