MEDICARE: HUGO SENIOR HOUSING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility		MN

General Provider Information

NPI Number	:	1114308616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUGO SENIOR HOUSING, LLC

Provider Business Mailing Address
First Line	:	3965 AIRPORT DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5845
Country	:	US
Telephone Number	:	317-280-8455
Fax Number	:	317-875-4051

Provider Business Practice Location Address
First Line	:	3965 AIRPORT DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5845
Country	:	US
Telephone Number	:	317-280-8455
Fax Number	:	317-875-4051

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. BRAD WOOD
Credential	:
Telephone Number	:	317-280-8455

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	06/11/2015

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