White River Lodge, LTD

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

4843 Issued in IN

Legal business name

WHITE RIVER LODGE, LTD

Practice address

3710 Kenny Simpson LN
Bedford, IN 47421-5632

Phone

(812) 275-7006

NPI assigned

May 23, 2007

Last updated

Jan 6, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brenda Premo

Title

Administrator

Phone

(812) 275-7006

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325808000000",
    "number": "1922218031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3710 KENNY SIMPSON LN",
            "city": "BEDFORD",
            "state": "IN",
            "postal_code": "474215632",
            "telephone_number": "812-275-7006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3710 KENNY SIMPSON LN",
            "city": "BEDFORD",
            "state": "IN",
            "postal_code": "474215632",
            "telephone_number": "812-275-7006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE RIVER LODGE, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2012-01-06",
        "status": "A",
        "authorized_official_last_name": "PREMO",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "812-275-7006"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IN",
            "license": "4843",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200155900A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacie Lenee Way, LMT
• Nickolaus M. Weiss, DDS
• Maranda Wells, RBT
• Westview West Outpatient Therapy Clinic
• Kevin Whelan, CRNA
• Breanna White
• Tyler Lee White, FNP-C
• Ashleigh Whiteman
• Whole Living Medical
• Amanda Wilson, NP

• Skilled Nursing Facility in Bedford, IN
• Providers in Bedford, IN by specialty
• Skilled Nursing Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.