Organization
LODGE OF THE WABASH, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL HUGININ (ADMINISTRATOR)
(812) 882-8787
Entity
Organization
Contact information
Practice address
723 E RAMSEY RD, VINCENNES, IN 47591-6128
(812) 882-8787
Mailing address
723 E RAMSEY RD, VINCENNES, IN 47591-6128
(812) 882-8787
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
4823
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200157070A
—
IN
Enumeration date
05/23/2007
Last updated
12/14/2011
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