MEDICARE: UNIVERSITY PLACE, 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	050036731	IN
2	314000000X	Skilled Nursing Facility	080036731	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831196369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY PLACE, INC

Provider Business Mailing Address
First Line	:	1700 LINDBERG RD
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-7317
Country	:	US
Telephone Number	:	765-464-5600
Fax Number	:	765-464-5605

Provider Business Practice Location Address
First Line	:	1750 LINDBERG RD
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-4956
Country	:	US
Telephone Number	:	765-464-5600
Fax Number	:	765-464-5605

Authorized Official
Title or Position	:	PRESIDENT AND C.E.O.
Name	:	MRS. JUDY AMIANO
Credential	:
Telephone Number	:	331-318-5200

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	02/28/2020

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Directions to “UNIVERSITY PLACE, INC ” Practice Location

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