Individual
STACEY PHIPPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1950 RIDGEDALE RD, SOUTH BEND, IN 46614-2243
(574) 291-6722
Mailing address
2612 SOUTHRIDGE DR, SOUTH BEND, IN 46614-1536
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
32001430A
IN
Other
Enumeration date
10/10/2011
Last updated
10/10/2011
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