Created on: 07/25/2025
Posted to the Web on: 08/06/2025
Basic Information
FACILITY CONTACT INFORMATION:
Address: 2725 LAKE CIRCLE DR
City: INDIANAPOLIS
Telephone: (317) 334-9400
Web Site:
NAME CHANGES:
Most recent name change: WILLOW LAKE PLACE
Date of most recent name change: 10/18/2023 12:25:50 PM
LICENSE INFORMATION:
License number: 24-010234-1
License effective date: 10/01/2024
License expiration date: 09/30/2025
Administration and Staff
Administrator: KOURTNEY HARVERY
Start date: 11/19/2024
Director of Nursing: SABRINA FULLER
Start date: 10/02/2023
Medical director:
Start date: / /
Wound care specialist:
Start date: / /
Infection preventionist:
Start date: / /
Ownership
CURENT OWNERSHIP:
Owning corporation: BLOOM AT WILLOW, LLC
260 E. BROWN STREET, STE #315
BIRMINGHAM MI 48009
Ownership type: PROFIT
Officer(s): BRADLEY DUBIN
ELIZABETH GOTTLIEB (DUBIN)
ANTHONY KANTOR
LISA GUTH (KANTOR)
SCOTT KANTOR
PREVIOUS OWNERSHIP CHANGES:
Name of previous owner: INDIANAPOLIS 2725 LAKE BG OPCO LLC
Date of last change of ownership: 10/02/2023
Bed Counts and Census
COMPREHENSIVE CARE BEDS:
Number of Medicaid beds (NF): 0
Number of Medicare beds (SNF): 0
Number of Medicare/Medicaid beds (SNF/NF): 0
Number of non-certified comprehensive care beds (State Licensed only): 0
Total number of comprehensive care beds: 0
RESIDENTIAL CARE BEDS:
Total number of residential beds: 86
Total number of beds in facility: 86
CENSUS:
Facility census: 44
As reported by the facility on: 09/16/2024
Number of comprehensive care beds occupied in this facility. 0
As reported by the facility on: 09/16/2024
Residential care beds occupied: 44
As reported by the facility on: 09/16/2024
Alzheimer Beds: 26
Alzheimer Beds Occupied: 26
As reported by the facility on: / /
Ventilator Beds: 0
Ventilator Beds Occupied: 0
As reported by the facility on: / /
Nurse Aide Training
NURSE AIDE TRAINING PROGRAM APPROVALS:
Nurse aide training and competency evaluation program (NATCEP) approved:
Nurse aide training and competency evaluation program (NATCEP) expires:
Nurse aide training and competency evaluation program (NATCEP) banned: No
Nurse aide training and competency evaluation program (NATCEP) ban expires: N/A
CLINICAL TRAINING SITES:
This facility is a Clinical training site for the following nurse aide training (NAT) classroom sites:
PIKE CAREER AND STEM CENTER
Approved: 01/25/2017
Terminated: N/A
Complaints
NUMBER OF SUBSTANTIATED COMPLAINTS:
Current year: 0
Previous year: 0
2 years previous: 0
State Licensure Surveys
The ISDH conducts a state licensure survey at each licensed residential facility
approximately once per year. If state findings are cited on a survey, the
residential facility may be requested by the ISDH to complete a plan of
correction on how and when they will correct each state finding and who will be
responsible to ensure the corrections are made and will not reoccur in the future.
The plan of correction is generally submitted by the residential facility and
reviewed by the ISDH within fifteen (15) days of the survey.
To read an overview of the survey process, click hereNOTE:
The residential consumer report survey information begins with surveys that
have been completed on or after December 1, 2008. Any survey performed prior
to that date will not have any information in the state findings count rows or
columns or will show zero.
07/30/2024 Most Recent
08/23/2023 2nd Most Recent
05/22/2019 3rd Most Recent
Number of state findings
5
5
8
State Average for the year of the survey (rounded to nearest whole integer).
