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General NPI Number Information
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NPI Number | 1619666500
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Entity Type | Organization
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Legal Business Name | CLARE BRIDGE OF CARMEL, LLC
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Dates
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Enumeration Date | 05/05/2023
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 301 EXECUTIVE DR
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City | CARMEL
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State | IN
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Zip | 46032-2984
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Country | US
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Telephone | 317-580-0389
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Fax |
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Provider Business Mailing Address
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Address Line | 6737 W WASHINGTON ST STE 2300
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City | MILWAUKEE
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State | WI
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Zip | 53214-5650
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Country | US
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Telephone | 414-918-5000
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | JOANNE LESKOWICZ
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Credential |
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Telephone | 414-918-5000
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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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