NPIMap

Organization Active NPI

Capital Senior Living Properties 4, Inc.

Doing business as CSL Fort Wayne, LLC

  • Assisted Living Facility
  • Fort Wayne, IN
National Provider Identifier
1083036974
Registry record updated Jan 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
13-012107-1 Issued in IN
Legal business name
CAPITAL SENIOR LIVING PROPERTIES 4, INC.
Doing business as
CSL Fort Wayne, LLC
Practice address
3320 East State Boulevard
Fort Wayne, IN 46805
Phone
(260) 483-4343
Fax
(812) 406-1101
NPI assigned
Jan 10, 2014
Last updated
Jan 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dan Kenyon
Title
VP and Secretary
Phone
(972) 770-5600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 13-012107-1 IN Primary

Addresses

Primary practice location

3320 East State Boulevard
Fort Wayne, IN 46805

Mailing address

3320 East State Boulevard
Fort Wayne, IN 46805
Phone (260) 483-4343

Other names 1

  • CSL Fort Wayne, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Capital Senior Living Properties 4 Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389312000000",
    "number": "1083036974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3320 EAST STATE BOULEVARD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46805",
            "telephone_number": "260-483-4343",
            "fax_number": "812-406-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3320 EAST STATE BOULEVARD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46805",
            "telephone_number": "260-483-4343",
            "fax_number": "812-406-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITAL SENIOR LIVING PROPERTIES 4, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-10",
        "last_updated": "2014-01-10",
        "status": "A",
        "authorized_official_last_name": "KENYON",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "VP AND SECRETARY",
        "authorized_official_telephone_number": "972-770-5600"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IN",
            "license": "13-012107-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CSL Fort Wayne, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.