Gumbo LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

28188157A Issued in IN

Legal business name

GUMBO LLC

Practice address

2618 River Ave
Mishawaka, IN 46544-1568

Phone

(269) 240-7881

NPI assigned

Nov 18, 2014

Organization subpart

No

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

Authorized official

Name

Michael Gumbo, R.N.,BSN

Title

Ceo

Phone

(269) 240-7881

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1416268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416268800000",
    "number": "1982000964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2618 RIVER AVE",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465441568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2618 RIVER AVE",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465441568",
            "telephone_number": "269-240-7881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUMBO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-18",
        "last_updated": "2014-11-18",
        "status": "A",
        "authorized_official_last_name": "GUMBO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "269-240-7881",
        "authorized_official_credential": "R.N.,BSN"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IN",
            "license": "28188157A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karly Rose Gruett, OD
• GSG Dental PC
• Paul Joseph Guentert, M.D.
• George Hibler Guerrant, D.M.D.
• Guiding Fluency LLC
• Ranjan Gupta, M.D.
• Gina A Gustafson, PMHNP
• Katherine Revah Guy, L.M.H.C.,L.A.C.,M.S.
• Joseph F Guzzi, PTA
• Michele M Hadary, MSW

• Skilled Nursing Facility in Mishawaka, IN
• Providers in Mishawaka, 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 Nov 18, 2014; 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.