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General NPI Number Information
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NPI Number | 1043902810
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Entity Type | Organization
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Legal Business Name | FORT WAYNE NURSING AND REHABILITATION LLC
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3320 E STATE BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46805-5601
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Country | US
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Telephone | 260-483-4343
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Fax |
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Provider Business Mailing Address
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Address Line | 7366 N LINCOLN AVE STE 301
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-1740
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Country | US
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Telephone | 847-602-8050
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Fax | 224-433-5153
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. AARON COHEN
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Credential |
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Telephone | 773-966-8045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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