Organization
GUMBO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL GUMBO R.N.,BSN (CEO)
(269) 240-7881
Entity
Organization
Contact information
Practice address
2618 RIVER AVE, MISHAWAKA, IN 46544-1568
(269) 240-7881
Mailing address
2618 RIVER AVE, MISHAWAKA, IN 46544-1568
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
28188157A
IN
Other
Enumeration date
11/18/2014
Last updated
11/18/2014
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