NPIMap

Organization Active NPI

KGC Operator, Inc.

Doing business as Brookdale Bloomington

  • Assisted Living Facility
  • Bloomington, IN
National Provider Identifier
1124717012
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
KGC OPERATOR, INC.
Doing business as
Brookdale Bloomington
Practice address
3802 S Sare Rd
Bloomington, IN 47401-4794
Phone
(812) 330-0885
NPI assigned
May 5, 2023
Last updated
Apr 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

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

Authorized official

Name
Anna F.C. Munoz
Title
Assistant Secretary
Phone
(414) 918-5443

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X NU Primary

Addresses

Primary practice location

3802 S Sare Rd
Bloomington, IN 47401-4794

Mailing address

3802 S Sare Rd
Bloomington, IN 47401-4794
Phone (812) 330-0885

Other names 1

  • Brookdale Bloomington Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Alterra Clare Bridge Cottage of SW Oklahoma City6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1683244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745798400000",
    "number": "1124717012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3802 S SARE RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474014794",
            "telephone_number": "812-330-0885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3802 S SARE RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474014794",
            "telephone_number": "812-330-0885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KGC OPERATOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-05",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A",
        "authorized_official_last_name": "MUNOZ",
        "authorized_official_first_name": "ANNA",
        "authorized_official_middle_name": "F.C.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "414-918-5443"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookdale Bloomington",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brookdale Bloomington",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; 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.