# ST PAUL HERMITAGE HOME

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871605055
- **Authorized official:** MAUREEN THERESE COONEY (BOOKKEEPER)
- **Authorized official phone:** (317) 786-2261

## Contact information

- **Practice address:** 501 N 17TH AVENUE, BEECH GROVE, IN 46107
- **Practice address phone:** (317) 786-2261
- **Practice address fax:** (317) 782-1411
- **Mailing address:** 501 N 17TH AVENUE, BEECH GROVE, IN 46107
- **Mailing address phone:** (317) 786-2261
- **Mailing address fax:** (317) 782-1411

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 060003911 | IN | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 06/17/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100274990A | — | IN |