# LODGE OF THE WABASH, LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780894899
- **Authorized official:** CHERYL HUGININ (ADMINISTRATOR)
- **Authorized official phone:** (812) 882-8787

## Contact information

- **Practice address:** 723 E RAMSEY RD, VINCENNES, IN 47591-6128
- **Practice address phone:** (812) 882-8787
- **Mailing address:** 723 E RAMSEY RD, VINCENNES, IN 47591-6128
- **Mailing address phone:** (812) 882-8787

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 4823 | IN | Yes |

## Other

- **Enumeration date:** 05/23/2007
- **Last updated:** 12/14/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200157070A | — | IN |