Provider Demographics
NPI:1396783932
Name:UMBRELLA FAMILY WAIVER SERVICES, LLC
Entity type:Organization
Organization Name:UMBRELLA FAMILY WAIVER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RIEBSOMER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:765-932-1332
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-0637
Mailing Address - Country:US
Mailing Address - Phone:765-932-1332
Mailing Address - Fax:765-932-1332
Practice Address - Street 1:208 W 1ST ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-1903
Practice Address - Country:US
Practice Address - Phone:765-932-1332
Practice Address - Fax:765-825-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN200445770B320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities