MEDICARE: UNIVERSITY HEIGHTS HEALTH & LIVING COMMUNITY

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	314000000X	Skilled Nursing Facility	05002711A	IN
2	225100000X	Physical Therapist	05002711A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	113911	OTHER	IN	COMMON ID PIN # FOR ANTHEM

General Provider Information

NPI Number	:	1275781866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY HEIGHTS HEALTH & LIVING COMMUNITY

Provider Business Mailing Address
First Line	:	1380 E COUNTY LINE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-0962
Country	:	US
Telephone Number	:	317-888-3581
Fax Number	:	317-885-1022

Provider Business Practice Location Address
First Line	:	1380 E COUNTY LINE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-0962
Country	:	US
Telephone Number	:	317-888-3581
Fax Number	:	317-885-1022

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. STEPHEN MOORE
Credential	:	M.D.
Telephone Number	:	812-332-2265

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	09/08/2008

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Directions to “UNIVERSITY HEIGHTS HEALTH & LIVING COMMUNITY ” Practice Location

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