Provider Demographics
NPI:1356996862
Name:THE WYNDMOOR OF EVANSVILLE, LLC
Entity type:Organization
Organization Name:THE WYNDMOOR OF EVANSVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LACHELE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:HENKLE WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:HFA, MBA, CLSS
Authorized Official - Phone:317-258-7031
Mailing Address - Street 1:6070 HUNTERS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-7919
Mailing Address - Country:US
Mailing Address - Phone:317-258-7031
Mailing Address - Fax:
Practice Address - Street 1:6521 GREENDALE DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-1741
Practice Address - Country:US
Practice Address - Phone:812-867-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN19-010681-1OtherISDH LICENSED RESIDENTIAL CARE