Provider Demographics
NPI:1902429822
Name:HELLENIC SENIOR LIVING OF MISHAWAKA LLC
Entity Type:Organization
Organization Name:HELLENIC SENIOR LIVING OF MISHAWAKA LLC
Other - Org Name:HELLENIC SENIOR LIVING OF MISHAWAKA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-845-3410
Mailing Address - Street 1:10706 SKY PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-7803
Mailing Address - Country:US
Mailing Address - Phone:317-845-3410
Mailing Address - Fax:317-288-0816
Practice Address - Street 1:1540 S. LOGAN STREET
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544
Practice Address - Country:US
Practice Address - Phone:574-257-8629
Practice Address - Fax:574-257-8634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility