Organization
ST PAUL HERMITAGE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAUREEN THERESE COONEY (BOOKKEEPER)
(317) 786-2261
Entity
Organization
Contact information
Practice address
501 N 17TH AVENUE, BEECH GROVE, IN 46107
(317) 786-2261
(317) 782-1411
Mailing address
501 N 17TH AVENUE, BEECH GROVE, IN 46107
(317) 786-2261
(317) 782-1411
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
060003911
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100274990A
—
IN
Enumeration date
08/31/2006
Last updated
06/17/2008
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