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General NPI Number Information
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NPI Number | 1255620431
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Entity Type | Organization
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Legal Business Name | LAMPLIGHT INN AT THE LELAND, LLC
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Dates
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Enumeration Date | 03/28/2011
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Last Update Date | 03/28/2011
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Provider Practice Location Address
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Address Line | 900 S A ST
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City | RICHMOND
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State | IN
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Zip | 47374-5558
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Country | US
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Telephone | 765-939-6500
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Fax | 765-965-6833
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Provider Business Mailing Address
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Address Line | 900 S A ST
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City | RICHMOND
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State | IN
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Zip | 47374-5558
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Country | US
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Telephone | 765-939-6500
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Fax | 765-965-6833
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Authorized Official
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Title or Position | CEO
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Name | SEVERINE PETRAS
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Credential |
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Telephone | 260-710-0304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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