Provider Information for 1598761074
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CHARTWELL MIDWEST INDIANA LLC
Organization Subpart: NO
NPI: 1598761074
Last Updated: 2008-01-07
Certification Date:
Certification Date:
Details
Name | Value | ||||||||||||||||||||
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NPI | 1598761074 | ||||||||||||||||||||
Enumeration Date | 2005-06-21 | ||||||||||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||||||||||
Status | Active | ||||||||||||||||||||
Authorized Official Information | Name: Mrs. SHARI LYNN PENTICUFF RN Title: General manager Phone: 3175943333 | ||||||||||||||||||||
Mailing Address | 4190 RELIABLE PKWY CHICAGO, IL 60684-0001 United States Phone: 317-594-3333 | Fax:317-594-3330 | ||||||||||||||||||||
Primary Practice Address | 8040 CASTLEWAY DR INDIANAPOLIS, IN 46250-1943 United States Phone: 317-594-3333 | Fax:317-594-3330 | ||||||||||||||||||||
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