Provider Demographics
NPI:1972514891
Name:WESTMINSTER VILLAGE NORTH, INC.
Entity type:Organization
Organization Name:WESTMINSTER VILLAGE NORTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-823-6841
Mailing Address - Street 1:11050 PRESBYTERIAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-2982
Mailing Address - Country:US
Mailing Address - Phone:317-823-6841
Mailing Address - Fax:317-826-8590
Practice Address - Street 1:11050 PRESBYTERIAN DRIVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-2982
Practice Address - Country:US
Practice Address - Phone:317-823-6841
Practice Address - Fax:317-826-8590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN050000841314000000X
IN09-000084-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100284600AMedicaid
155167Medicare Oscar/Certification