Organization
COUNTRY CHARM VILLAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. C. DIEDERICK VAN DER VELDE (PRESIDENT)
(502) 500-7798
Entity
Organization
Contact information
Practice address
7212 US 31 S, INDIANAPOLIS, IN 46227-8549
(317) 889-9822
(317) 889-6500
Mailing address
7212 U.S. HWY 31 S., INDIANAPOLIS, IN 46227-8549
(317) 889-9822
(317) 889-6500
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
12-003283-1
IN
Other
Enumeration date
05/14/2012
Last updated
05/14/2012
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