Crestmark of Roselawn

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CRESTMARK OF ROSELAWN

Practice address

10352 N 600 E
Demotte, IN 46310-8959

Phone

(219) 345-5211

NPI assigned

Oct 10, 2005

Last updated

Aug 22, 2020By 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

Mrs. Dana Friedrichs

Title

Administrator

Phone

(219) 345-5211

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902894462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10352 N 600 E",
            "city": "DEMOTTE",
            "state": "IN",
            "postal_code": "463108959",
            "telephone_number": "219-345-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10352 N 600 E",
            "city": "DEMOTTE",
            "state": "IN",
            "postal_code": "463108959",
            "telephone_number": "219-345-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTMARK OF ROSELAWN",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FRIEDRICHS",
        "authorized_official_first_name": "DANA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "219-345-5211",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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.