2339 South Sr 135 Tenant LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

2339 SOUTH SR 135 TENANT LLC

Doing business as

Grand Victorian of Greenwood

Practice address

2339 South State Street Road 135
Greenwood, IN 46143

Phone

(317) 371-4803

Fax

(317) 535-0425

NPI assigned

Oct 30, 2024

Last updated

Oct 30, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Greg Echols

Title

Co-President of Its Management Agen

Phone

(779) 216-5849

Specialties & licenses 1

Addresses

Other names 1

• Grand Victorian of Greenwood Doing business as

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

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1346062353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E COURT ST STE 400",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013848",
            "telephone_number": "815-935-1992",
            "fax_number": "815-935-8380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2339 SOUTH STATE STREET ROAD 135",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "46143",
            "telephone_number": "317-371-4803",
            "fax_number": "317-535-0425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "2339 SOUTH SR 135 TENANT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-30",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-25",
        "status": "A",
        "authorized_official_last_name": "ECHOLS",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "CO-PRESIDENT OF ITS MANAGEMENT AGEN",
        "authorized_official_telephone_number": "779-216-5849",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Victorian of Greenwood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• A Dental Touch LLC
• A New Day Counseling and Education Services, LLC
• A New Smile, P.C.
• A-Warnock LLC
• Aaa Hoosier Cab LLC

• Assisted Living Facility in Greenwood, IN
• Providers in Greenwood, IN by specialty
• Assisted Living Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; 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.