| NPI | 1982964433 |
|---|---|
| Doing Business As | LODGE OF THE WABASH |
| Entity Type | Organization |
| Authorized Contact | BRAD SMITH President/CEO 765-932-7513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2012-10-01 |