Provider Demographics
NPI:1255620431
Name:LAMPLIGHT INN AT THE LELAND, LLC
Entity type:Organization
Organization Name:LAMPLIGHT INN AT THE LELAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEVERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-710-0304
Mailing Address - Street 1:900 S A ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5558
Mailing Address - Country:US
Mailing Address - Phone:765-939-6500
Mailing Address - Fax:765-965-6833
Practice Address - Street 1:900 S A ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5558
Practice Address - Country:US
Practice Address - Phone:765-939-6500
Practice Address - Fax:765-965-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility