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COUNTRY CHARM VILLAGE LLC
NPI 1225397011
Assisted Living Facility in Indianapolis, IN

Active since May 14, 2012CLIA 15D1015439 · Waiver
7212 US 31 S, INDIANAPOLIS, IN 46227(317) 889-9822(317) 889-6500 Get Directions Write a Review

NPPES record last updated: May 14, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Country Charm Village Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COUNTRY CHARM VILLAGE LLC (NPI 1225397011) is a healthcare organization registered as an assisted living facility in Indianapolis, Indiana and active in the NPI registry since May 2012. The organization holds a CLIA Waiver certificate valid through July 30, 2027 and lists C. Diederick Van Der Velde, President, as its authorized official.

NPPES Registry Identity

NPI1225397011
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameCOUNTRY CHARM VILLAGE LLC
Location Address7212 US 31 SIndianapolis, IN 46227-8549
Mailing Address7212 U.s. Hwy 31 S.Indianapolis, IN 46227-8549 · (317) 889-9822 · Fax (317) 889-6500
Phone(317) 889-9822
Fax(317) 889-6500
Organization SubpartNo
Authorized OfficialC. Diederick Van Der VeldePresident · (502) 500-7798
Enumeration DateMay 14, 2012
✔ NPI 1225397011 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in IN · 12-003283-1
Definition
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.
7212 US 31 S, Indianapolis, IN 46227
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D1015439

Country Charm Village · Indianapolis, IN
Active · expires Jul 30, 2027
CLIA Number15D1015439
Laboratory TypeOther
Certificate Effective DateJuly 31, 2025
Certificate Expiration DateJuly 30, 2027
Laboratory DirectorSherrie K. Mitchell
Laboratory Phone(317) 889-9822
Laboratory LocationCountry Charm Village7212 Us Hwy 31 South, Indianapolis, IN 46227
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHELLE DIANE MCKINNEY PT
Physical Therapist
7212 US 31 S
INDIANAPOLIS, IN 46227
Marion County (317) 889-9822
EMERITUS PROPERTIES NGH, LLC
Assisted Living Facility
7212 US 31 S
INDIANAPOLIS, IN 46227
Marion County (317) 889-9822
LAURA C MAYER OTR/L
Occupational Therapist
7212 US 31 S
INDIANAPOLIS, IN 46227
Marion County (317) 889-9822
CAROL BLUME
Occupational Therapist
7212 US 31 S
INDIANAPOLIS, IN 46227
Marion County (317) 889-9822
AEGIS GROUP PRACTICE LLC
Physical Therapist
7212 US 31 S
INDIANAPOLIS, IN 46227
Marion County (800) 444-6845

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Country Charm Village LLC's NPI number?

The NPI number for Country Charm Village LLC is 1225397011. It was assigned to this organization in the NPPES registry on May 14, 2012.

Where is Country Charm Village LLC located?

Country Charm Village LLC is located at 7212 Us 31 S, Indianapolis, IN 46227. The listed phone number is (317) 889-9822.

What is Country Charm Village LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Country Charm Village LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D1015439) is associated with this NPI, valid through July 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Country Charm Village LLC was last updated on May 14, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.