MEDICARE: VOP GENTRY PARK, 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

General Provider Information

NPI Number	:	1568359008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VOP GENTRY PARK, LLC

Provider Business Mailing Address
First Line	:	901 S HASTINGS DR
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-8205
Country	:	US
Telephone Number	:	816-668-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 S HASTINGS DR
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-8205
Country	:	US
Telephone Number	:	816-668-1200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTIAN N CUMMINGS
Credential	:
Telephone Number	:	312-660-3800

Provider Enumeration Date	:	06/18/2025
Last Update Date	:	02/18/2026

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