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NPI Code Detail

MEDICARE: HAVEN OF WABASH, LLC

MEDICARE: HAVEN OF WABASH, 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1922987429
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAVEN OF WABASH, LLC
Provider Business Mailing Address
First Line : 2201 MAIN ST
Second Line :
City : EVANSTON
State : IL
Zip : 60202-1519
Country : US
Telephone Number : 773-989-3000
Fax Number :
Provider Business Practice Location Address
First Line : 320 S 2ND ST
Second Line :
City : GRAYVILLE
State : IL
Zip : 62844-1527
Country : US
Telephone Number : 618-375-1371
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. LEVI ISRAEL
Credential :
Telephone Number : 847-905-3283
Provider Enumeration Date : 08/28/2025
Last Update Date : 08/28/2025

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Directions to “HAVEN OF WABASH, LLC ” Practice Location

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