Organization
LAMPLIGHT INN OF FORT WAYNE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SEVERINE PETRAS (CEO)
(260) 710-0304
Entity
Organization
Contact information
Practice address
300 E WASHINGTON BLVD, FORT WAYNE, IN 46802-3124
(260) 422-5511
(260) 422-3778
Mailing address
300 E. WASHINGTON BLVD., FORT WAYNE, IN 46802
(260) 422-5511
(260) 422-3778
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
04/01/2011
Last updated
04/01/2011
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