Provider Demographics
NPI:1659595411
Name:WABASH CENTER, INC.
Entity Type:Organization
Organization Name:WABASH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHRO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-423-5531
Mailing Address - Street 1:PO BOX 6449
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-6449
Mailing Address - Country:US
Mailing Address - Phone:765-423-5531
Mailing Address - Fax:765-423-4235
Practice Address - Street 1:744 S 26TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3360
Practice Address - Country:US
Practice Address - Phone:765-447-4576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100235370AMedicaid