CAPITAL SENIOR LIVING PROPERTIES 4, INC. (NPI# 1083036974) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083036974 |
| Entity Type | Organization |
| Organization Name | CAPITAL SENIOR LIVING PROPERTIES 4, INC. |
| Other Organization Name | CSL FORT WAYNE, LLC |
| Practice Address |
3320 East State Boulevard Fort Wayne IN 46805 |
| Practice Telephone | 2604834343 |
| Practice Fax Number | 8124061101 |
| Mailing Telephone | 2604834343 |
| Mailing Fax Number | 8124061101 |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2014-01-10 |
| Authorized Official Name | DAN KENYON (VP AND SECRETARY) |
| Authorized Official Telephone | 9727705600 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 13-012107-1 | IN | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| CSL Fort Wayne, LLC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841612835 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 5865 Sugar Lane, Plainfield, IN 46168 | 2014-01-10 |
| 1891117784 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 2400 Market Street, Charlestown, IN 47111 | 2014-01-10 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | CAPITAL SENIOR LIVING PROPERTIES 4, INC. | 14160 Dallas Parkway, Suite 300, Dallas, TX 75254 |
| Indiana Business Entities | CAPITAL SENIOR LIVING PROPERTIES 4, INC. | 14160 Dallas Pkwy, Ste 300, Dallas, TX 75254 |
| Street Address |
3320 EAST STATE BOULEVARD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46805 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619589546 | Connor Gemlick | Student in an Organized Health Care Education/Training Program | 1918 Carew St., Fort Wayne, IN 46805 | 2020-08-21 |
| 1710464086 | S.t.a.r. Care Services | Clinic/Center | 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 | 2018-07-19 |
| 1083122865 | Noel Shafi | Counselor | 3010 East State Boulevard, Fort Wayne, IN 46805 | 2018-01-16 |
| 1063963627 | Toni L Irby | Specialist | 3219 E State Blvd, Fort Wayne, IN 46805 | 2016-10-19 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1063817104 | Michale Diane Rothgeb | Physical Therapy Assistant | 2200 Randollia Dr, Fort Wayne, IN 46805 | 2014-10-31 |
| 1124435789 | Julia I. Mcfann | Physical Therapist | 2200 Randalia Dr, Fort Wayne, IN 46805 | 2014-07-16 |
| 1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
| 1043595689 | Randy James Jennings | Pharmacist | 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 | 2011-10-14 |
| 1174706691 | Valerie J Rumple | Registered Nurse | 1909 Carew St, Fort Wayne, IN 46805 | 2007-12-06 |
| Find all providers in zip 46805 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740895390 | The Health and Hospital Corporation of Marion County | Assisted Living Facility | 2002 Heritage Park Dr, Fort Wayne, IN 46805-5806 | 2020-09-10 |
| 1730712886 | Cook Road Aal Lp | Assisted Living Facility | 3731 W Cook Rd, Fort Wayne, IN 46818-9403 | 2020-02-18 |
| 1194358119 | Ev Fw Limited Partnership | Assisted Living Facility | 12523 Auburn Rd, Fort Wayne, IN 46845-8797 | 2020-02-18 |
| 1073006938 | Fort Wayne Aal Lp | Assisted Living Facility | 7125 S Hanna Street, Fort Wayne, IN 46816 | 2018-06-14 |
| 1801205240 | Pulaski Memorial Hospital | Assisted Living Facility | 5250 Heritage Pkwy, Fort Wayne, IN 46835-1061 | 2014-08-11 |
| 1063701886 | Lamplight Inn of Fort Wayne, LLC | Assisted Living Facility | 300 E Washington Blvd, Fort Wayne, IN 46802-3124 | 2011-04-01 |
| 1396034237 | Park Place Senior Living, LLC | Assisted Living Facility | 4411 Park Place Dr, Fort Wayne, IN 46845-8793 | 2011-03-31 |
| 1225212475 | The Health and Hospital Corporation of Marion County | Assisted Living Facility | 7833 W. Jefferson Blvd, Fort Wayne, IN 46804 | 2007-12-24 |
| 1093900672 | Assisted Living Concepts Inc | Assisted Living Facility | 2116 Butler Road, Fort Wayne, IN 47150 | 2007-09-07 |
| 1841365434 | Five Star Quality Care - Obx Operator, LLC | Assisted Living Facility | 2601 Covington Commons Drive, Fort Wayne, IN 46804 | 2006-11-21 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46805 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.