Provider Demographics
NPI:1699710392
Name:APOSTOLIC CHRISTIAN RETIREMENT HOME, INC
Entity type:Organization
Organization Name:APOSTOLIC CHRISTIAN RETIREMENT HOME, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINASTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-567-9149
Mailing Address - Street 1:101 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:FRANCESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47946-8316
Mailing Address - Country:US
Mailing Address - Phone:219-567-9149
Mailing Address - Fax:219-567-2646
Practice Address - Street 1:101 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:FRANCESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47946-8316
Practice Address - Country:US
Practice Address - Phone:219-567-9149
Practice Address - Fax:219-567-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000389220OtherBLUE CROSS/BLUE SHIELD
IN000000389220OtherBLUE CROSS/BLUE SHIELD