1053619841 NPI number — STRATFORD RETIREMENT, LLC

Table of content: (NPI 1053619841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053619841 NPI number — STRATFORD RETIREMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRATFORD RETIREMENT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE RETREAT AT THE STRATFORD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053619841
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2460 GLEBE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032-7154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-733-9650
Provider Business Mailing Address Fax Number:
317-733-9651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2460 GLEBE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032-7154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-733-9650
Provider Business Practice Location Address Fax Number:
317-733-9651
Provider Enumeration Date:
03/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BEAM
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
704-246-1611

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  10-011151-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311500000X , with the licence number: 10-011151-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 14-011151-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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