Provider Demographics
NPI:1629733662
Name:SWEET GALILEE AT THE WIGWAM, LLC
Entity Type:Organization
Organization Name:SWEET GALILEE AT THE WIGWAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-377-1790
Mailing Address - Street 1:1630 N MERIDIAN ST STE 350
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1462
Mailing Address - Country:US
Mailing Address - Phone:317-377-1790
Mailing Address - Fax:
Practice Address - Street 1:1315 JOHN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-3558
Practice Address - Country:US
Practice Address - Phone:317-377-1790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility