# GUMBO LLC

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

## Provider details

- **NPI number:** 1982000964
- **Authorized official:** MICHAEL GUMBO R.N.,BSN (CEO)
- **Authorized official phone:** (269) 240-7881

## Contact information

- **Practice address:** 2618 RIVER AVE, MISHAWAKA, IN 46544-1568
- **Practice address phone:** (269) 240-7881
- **Mailing address:** 2618 RIVER AVE, MISHAWAKA, IN 46544-1568

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 28188157A | IN | Yes |

## Other

- **Enumeration date:** 11/18/2014
- **Last updated:** 11/18/2014