MEDICARE: SABRA INDIANA OPERATIONS IV, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1366387961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SABRA INDIANA OPERATIONS IV, LLC

Provider Business Mailing Address
First Line	:	6727 BELLE PLAIN CV
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-1876
Country	:	US
Telephone Number	:	260-452-4896
Fax Number	:	260-452-4896

Provider Business Practice Location Address
First Line	:	3100 UTICA SELLERSBURG RD
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-8528
Country	:	US
Telephone Number	:	812-818-1414
Fax Number	:

Authorized Official
Title or Position	:	DIR OF BUSINESS OFFICE
Name	:	KRIS PETERS
Credential	:
Telephone Number	:	260-452-4896

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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