Organization
THE WYNDMOOR OF PORTAGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LACHELE HENKLE WEAVER HFA, MBA, CLSS (OWNER/OPERATOR)
(317) 258-7031
Entity
Organization
Contact information
Practice address
3444 SWANSON RD, PORTAGE, IN 46368-4999
(219) 763-4867
(219) 299-6570
Mailing address
3444 SWANSON RD, PORTAGE, IN 46368-4999
(219) 763-4867
(219) 299-6570
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19-010889-2
INDIANA STATE DEPARTMENT OF HEALTH RESIDENTIAL CARE LICENSE
IN
Enumeration date
08/02/2019
Last updated
08/02/2019
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