NPIMap

Organization Active NPI

Christole, Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Bloomington, IN
National Provider Identifier
1275627036
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
2510S0011DE05 Issued in IN
Legal business name
CHRISTOLE, INC
Practice address
1701 Winslow Drive
Bloomington, IN 47404
Phone
(812) 336-4711
Fax
(812) 336-4781
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Robert B. Clemons
Title
C E O
Phone
(812) 988-1257

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 2510S0011DE05 IN Primary

Addresses

Primary practice location

1701 Winslow Drive
Bloomington, IN 47404

Mailing address

200 Hawthorne
Nashville, IN 47448
Phone (812) 988-1257

Other identifiers 1

IdentifierTypeStateIssuer
2510S0011DE05MedicaidIN

National Provider Directory

National Provider Directory
Tax ID family
Christole Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

200 Hawthorne Dr
Nashville, IN 47448
Phone (812) 988-1257

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275627036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HAWTHORNE",
            "city": "NASHVILLE",
            "state": "IN",
            "postal_code": "47448",
            "telephone_number": "812-988-1257",
            "fax_number": "812-988-1736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 WINSLOW DRIVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47404",
            "telephone_number": "812-336-4711",
            "fax_number": "812-336-4781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTOLE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLEMONS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "C E O",
        "authorized_official_telephone_number": "812-988-1257",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IN",
            "license": "2510S0011DE05",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2510S0011DE05",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 2020; 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.