Provider Demographics
NPI:1417320359
Name:WABASH VALLEY SAFEKEEPERS LLC
Entity Type:Organization
Organization Name:WABASH VALLEY SAFEKEEPERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-201-4239
Mailing Address - Street 1:4270 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47805-8628
Mailing Address - Country:US
Mailing Address - Phone:812-201-4542
Mailing Address - Fax:812-917-2870
Practice Address - Street 1:4270 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47805-8628
Practice Address - Country:US
Practice Address - Phone:812-201-4542
Practice Address - Fax:812-917-2870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-31
Last Update Date:2015-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN15-013-747-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care