Gumbo LLC
Skilled Nursing Facility in Mishawaka, IN. Organization (NPI-2).
NPI number1982000964
StatusActive
Last updated in NPPESNov 18, 2014
Details
- NPI
- 1982000964
- Entity type
- Organization (NPI-2)
- Legal business name
- Gumbo LLC
- Organization subpart
- No
- Enumeration date
- Nov 18, 2014
- Last updated
- Nov 18, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 314000000X | Skilled Nursing Facility | 28188157A | IN | Yes |
Practice location
2618 River AveMishawaka, IN 46544-1568
Phone 269-240-7881
Mailing address
2618 River AveMishawaka, IN 46544-1568
Authorized official
Michael Gumbo
Ceo
2692407881
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All 8 Skilled Nursing Facility providers in Mishawaka · All 1,883 providers in Mishawaka
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