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General NPI Number Information
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NPI Number | 1568266849
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Entity Type | Organization
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Legal Business Name | FT WAYNE IN OPCO 2 LLC
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 4730 E STATE BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46815-6975
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Country | US
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Telephone | 260-484-0308
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Fax |
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Provider Business Mailing Address
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Address Line | 4730 E STATE BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46815-6975
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | AARON KASPER
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Credential |
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Telephone | 646-450-6051
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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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