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General NPI Number Information
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NPI Number | 1821963091
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Entity Type | Organization
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Legal Business Name | COMMONS AT JACKSON CREEK LLC
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Dates
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Enumeration Date | 10/08/2025
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 3802 S SARE RD
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City | BLOOMINGTON
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State | IN
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Zip | 47401-4794
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Country | US
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Telephone | 260-740-3220
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Fax | 260-498-2059
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Provider Business Mailing Address
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Address Line | 5904 E STATE BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46815-7637
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Country | US
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Telephone | 260-740-3220
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Fax | 260-498-2059
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Authorized Official
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Title or Position | MEMBER/CEO
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Name | SHERRI BERGHOFF
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Credential |
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Telephone | 260-740-3220
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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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