Wanda Bontrager
Individual provider Active NPI Skilled Nursing Facility · Goshen, IN
NPI 1093090730 · NPPES record last updated Oct 13, 2011
Key facts
- NPI
- 1093090730
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 31000534A (IN)
- Practice address
- 404 Mount Vernon Dr
Goshen, IN 46526-1432 - Phone
- (574) 533-4933
- NPI assigned
- Oct 13, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31000534A | IN | MD | Skilled Nursing Facility |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 31000534A | IN | Yes |
Addresses
Primary practice location
404 Mount Vernon Dr
Goshen, IN 46526-1432
Mailing address
404 Mount Vernon Dr
Goshen, IN 46526-1432
Other providers in Goshen, IN
- Boling Vision Center, LLC
- Oluwakemi Gbemisola Bond
- Amy Bontrager
- Cynthia Bontrager
- Serenity Bontrager
- Alexandria Booker
- Sam Joseph Borrelli
- Muhammad B Bostaji
- Charles W Bower
- Tammy Bowers
All providers in Goshen, IN · Skilled Nursing Facility in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 13, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.