MEDICARE: FRIENDS FELLOWSHIP COMMUNITY, INC.

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	07-001128-1	IN
2	311500000X	Alzheimer Center (Dementia Center)	07-001128-1	IN
3	313M00000X	Nursing Facility/Intermediate Care Facility	07-001128-1	IN

General Provider Information

NPI Number	:	1427215706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIENDS FELLOWSHIP COMMUNITY, INC.

Provider Business Mailing Address
First Line	:	2030 CHESTER BLVD
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1215
Country	:	US
Telephone Number	:	765-962-6546
Fax Number	:	765-962-9188

Provider Business Practice Location Address
First Line	:	2030 CHESTER BLVD
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1215
Country	:	US
Telephone Number	:	765-962-6546
Fax Number	:	765-962-9188

Authorized Official
Title or Position	:	VP FINANCE & DEVELOPMENT
Name	:	MR. JOHN C. ROBINSON
Credential	:
Telephone Number	:	765-962-6546

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	05/22/2008

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