1992750756 NPI number — PARAMOUNT OF INDIANAPOLIS, LLC

Table of content: LORI G CLIFTON CCC/SLP (NPI 1467453340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992750756 NPI number — PARAMOUNT OF INDIANAPOLIS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARAMOUNT OF INDIANAPOLIS, 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:
CAMBRIDGE MANOR NURSING & REHABILITATION CENTER
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:
1992750756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 EVERGREEN RD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40243-1010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-254-4949
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8530 TOWNSHIP LINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46260-1927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-876-9955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TURNER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
VICE PRESIDENT OF FINANCE
Authorized Official Telephone Number:
520-254-4949

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  05-000195-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BN1400X , with the licence number: 100267690B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 100267690B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100267690B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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